I received word from my i...

I received word from my insurance MAMSI that there is an exclusion on my policy. Can someone help me, I am so discouraged. I don't know whether it is even worth it to even go any further. I havent finished my 6 month docotor supervised weight loss yet, so I dont know what I should do. Any help would be greatfully appreciated Thanks Cathy

Dear Cathy, Regarding your MAMSI insurance and their exclusion: i would need more information in order to guide you. 1. Is this policy written in Maryland or DC? In other words, is the employer a DC employer or a Maryland employer? 2. If this is a Maryland policy, is this a small group employer (under 50 employees) or a large group employer? 3. After you find all of this out then you would need to find out if the policy is a self-funded policy or not. And if it is what kind of policy it is such as a PPO, HMO or POS. 4. Also the wording of the exclusion can sometimes be misleading so it is helpful at times to know exactly what the exclusion says. All of this information is needed to figure out whether or not the policy is governed under the Maryland mandate for the treatment of morbid obestiy. I may be able to point you in the direction of State officials who are in positon to help but only if the mandate covers this. Find all of this and get back to me. I'm more than happy to help. (Note: You may get a better response rate to your post if you put a title in your subject line.) Michelle "Pookie" Engelmann Founder and Co-Chair MD WLS Legislative Action Committee also Vice Chair Maryland Task Force for the Study of the Utilization and Review of the Surgical Treatment of Morbid Obesity

Michelle, Cathy posted some additional information in an earlier post last week, which I've pasted below, along with my reply: Response from Catherine Lipscomb at 6:48 AM PST on 05/29/2005 Brunswick, MD My husband works for a construction company and has a small group policy, but I am sure that they have more than 50 employees. When I called (MAMSI) they said that the decision is made on a case by case basis. Do you think that means that it wont be covered? They said that I need a 6 month doctor supervised weight loss and a psych eval before even considering according to my surgeons office Thanks Cathy RE: RE: Response from Leesa W at 10:06 AM PST on 05/29/2005 North Bethesda, MD Cathy, There are a few "quirks" in the Maryland law. First, if the company once was under 50 full-time employees, and now has grown, but they haven't changed the underlying health plan insurer since they've topped the 50 FT employee limit, they may still have a small group policy, and can maintain it until such time as they change insurance companies. Second, if the health plan is through a union-based plan, it may be self-funded and, therefore, not subject to the jurisdiction of the Maryland law. In either event, if the WLS coverage is through a rider to the policy, and the policy is not subject to the Maryland law, the insurance company may have more discretion they're permitted to exercise in determining qualifications for "medical necessity." The 6-month supervised weight loss plan and psych evaluation are becoming standard requirements for approval of WLS. The State Task Force established by the Maryland General Assembly has recommended that the 6-month supervised weight loss plan be made a bit more flexible with alternative ways of achieving the same goal. However, right now, that's what it is, is a recommendation, and the Maryland Insurance Administration has been tasked to establish standard criteria for approval for WLS under the Maryland statute -- that is, for situations when the statute is applicable. If the statute doesn't apply, it's up to the insurance company to establi****s own criteria, assuming WLS is even included in the plan in the first place. Leesa **************** As you indicated, some additional information is required, particularly if the health plan is through a union and/or is self-funded (as many union-based plans are). Leesa Weiss Co-Founder & Co-Chair Maryland Weight Loss Surgery Legislative Action Committee

Leesa- Yes, I had seen that. Evidently Cathy needs further help than what was previously proffered so I thought I would offer to help as well. I hope that she is able to get this information out to us or to whomever can help her so that is is able to have the WLS that she wants. In any event, the list of questions may be useful for others as well. Michelle "Pookie" Engelmann Founder and Co-Chair Maryland Weight Loss Surgery Legislative Action Committee and Vice Chair Maryland Task Force for the Study of the Utilization and Review of the Surgical Treatment of Morbid Obesity

I thought I had the answer by signing up for insurance at my own job, the insurance coodinator called MAMSi and they told her it was covered under the policy that we just signed up for and so I started the enrollment process. I work in Va and live in MD. Today they send me an urgent email stating that they had made a mistake and that the surgery wasn't covered. They said that the new enrollments were scattered everywhere and they didnt get a chance to really go through the policy until today. Does this sound fish to you? I don't know what to do now. I contacted the insurance coordinator at my job and she supposedly called and found out that it would affect everybody's premium too much to add this to the policy. Do you have any other suggestions for me. I am going to call my husbands job and see if they might add this to their policy, but I doubt they will because of having so few employees and only two of them being women. Any suggestions would be helpful. Thanks Cathy