MAMSI INSURANCE
No. My surgeons office said that Mamsi requires 6 months diet supervised weight loss and the psych visit before anything will be considered. I just dont know what they require as far as "diet supervised" whether that means just a weigh in every month or that I have to document with my doctor what diet I am using or what? I have my psych visit this week, but wont have 6 months supervised until either July or August, depending on what they consider Physician supervised.
What was your experience?
Cathy
Hmmh. I didn't have a 6 month diet history under the care of a doctor. I actually referenced one of the obesityhelp.com links to prepare my paperwork. I put together all of the diets I've tried over the course of a 10 year period. Part of this included getting Jenny Craig to write a letter stating when I join (each time I tried the program - approximately 3 times), my starting weight, ending weight and how long I was on the program. I had also tried weigh****chers and made a photo copy of the log, detailing beginning and ending weight and how long I was on the program. My primary care physician wrote a letter detailing my weight at the time I first began seeing her and my then current weight. Years ago I had tried the diet pill Xenecal. I took it for probably 1-2 months. I contacted that physician and asked that they send me my medical records. I think I provided the insurance company with SO much information that it helped with my getting approval on the first try.
I would think that if you have documentation, or can get it, for any diet programs you've tried, that lasted more than 4 months, it should be sufficient. The more attempts you've made should support your case. If your doctor could write a letter, as well, stating any types of diets you may have tried - and mentioned during a visit to your doctors office - that should work in your favor as well. Worse case scenario August not that far off. Make monthly or bi-monthly appointments with your doctor to weight in. Once this is accomplished ask for documentation to submit to MAMSI. Lastly, you could call MAMSI and request clarification on what they, specificially, want and for them to define "supervised."
Thanks, I have written down all the diets I have tried and I have records from Weigh****chers, but the lady at the surgeons office said that they wont take those. I was on a few other Commercial Plans, but one was years ago and went out of business and one was LA Weight Loss, but I dont know if they would have my records from 2001. I also have used Herbalife twice. I will try to get some kind of record from them also. I just never thought I would need the records for antyhing so I didnt keep them after a while.
Thanks
Cathy
I disagree with your surgeon's statement that MAMSI won't accept documentation from Weigh****chers, or any other commerical plan. A diet attempt is a diet attempt and though surgeon's (and or their staff) may interact with insurance companies often they are not the first authority - No offense meant by this.
My mother used to work in the utilization review department at mamsi. She encouraged me to submit documents from WW and Jenny Craig. There is a 50% chance they could say no but you'll never know until you try it. My approval was given without my even having an official psych evaluation. When I told my surgeon's secretary this she was floored. I don't think that she believe me when I told her they approved the request. She called, of course, to verify my claim. So, what I'm saying is that sometimes the insurance companies surprise both us as the carrier and the surgeons.
Don't worry about the length of time that's passed from when you last were a client at LA weight Loss Center. I think most organizations will keep records on hand for about 10 years. Anything beyond that would have to, in all likelihood, be researched and thus a letter would take longer. I think that if you can provide a receipt of purchase for Herbalife and a personal statement detailing when you first tried it, how long you took it and your starting and ending weight that MAMSI will accept this.
If you have meantioned any other diet attempts to your primary doctor, prior to getting a referral for gastric bypass, ask that they write a letter. If they can document starting and ending weight this would be great.
When I was waiting for my consult I referenced the following link and began submitting paperwork to my surgeon, with the intent for it to be sent to my insurance company for pre-authorization. The day of my consult I knew I wanted the surgery and asked that they submit for authorization that day.
http://www.obesityhelp.com/morbidobesity/m-surgeonsearch.phtml
Too, under "your profile" on the Obesityhelp.com site there is a "Pre-Op" information category. I printed it out and referenced the listing of "weight loss programs." If you have any information noted under this option I suggest you screen print it out and submit it to MAMSI, along with your other information.
Bottom line is that the lady at your surgeons office should work with you to seek approval, even if it means doing something outside the ordinary.
Good luck to you and I'll keep you in my prayers!
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