Question:
DENIED Can't Appeal!!!!! Insurance company covers NOTHING!

I recently found out that I was denied by our old insurance company (Cigna). I forgot on which basis I was denied (some off the wall b/s) but I wrote it down and once I find out where I put it, I'll post it. But, anyway, I can't appeal the rejection letter because we are switching insurance companies the first of the year. This insurance doesn't cover anything at all as far as WLS. I'm not sure what to do. Is there any way they will cover it. The insurance company, by the way, is Mamsi. I really appreciate it!    — blank first name B. (posted on December 7, 2001)

December 7, 2001
Amanda, I do not have Mamsi, but my insurance company also said they do not cover any kind of weight lose procedures. After writing to them (both my surgeon and I) I was approved, no questions asked. My advise to you is not to give up until you have tried and then appeal if they do decline you. Mamsi is through Optiumum Choice and is usually a HMO, which means you have to use thier doctors, and they are usually less likely to cover alot of procedures, but like I said you need to fight tooth and nail if this is something you really want. I used to work for a doctor and Optimum Choice and Mamsi were the first to deny alot of procedues, but i think you will find that persistence goes a long way.I am not saying you can win them over, but its worth a long and hard fight on your part.. I wish you the best
   — Malynda S.

December 7, 2001
Hi Amanda! I don't have Mamsi either, but I did find some stuff in the database about them. My first suggestion is, if you can afford it, to opt for the PPO plan. I had Cigna PPO and was approved, I hear that the HMO is harder. It's probably the same with most companies. Here is the info on Mamsi: MAMSI Approved after first letter (08/19/99) Laparoscopic RNY Weeks to approval : Pre-Op BMI : 49.1 Comorbidities : GERD, and arthritis Policy : Must be medically necessary Comments : MAMSI came back asking for documentation of my GERD and a psychological eval. After they received the additional information I was immediately approved. ------------------------------------------------------------------------ MAMSI (PPO) Approved after first letter (6/1/99) Laparoscopic Other Weeks to approval : 2 Pre-Op BMI : Comorbidities : Sleep apnea, arthritis, borderline hypertension, depression Policy : Must be medically necessary Comments : They were wonderful to me. After receiving a request for more information on co-morbidities and physician-supervised diets, I sent them everything. Within 24 hours of receiving the information, I was approved. I sent an especially poignant personal letter also. And I telephone the quality assurance contact personally. I recommend begin very organized (I sent my information in a binder with dividers identifying each portion so they could find everything quickly) and involved. Don't wait to be contacted - contact them first. ------------------------------------------------------------------------ ------------------------------------------------------------------------ MAMSI-MD IPA (Federal Plan) Approved after appeal letter (06/13/01) Open RNY Weeks to approval : 3 Pre-Op BMI : 51.9 Comorbidities : arthritis, swelling in feet/legs, snoring, reflux, upper/lower back pain Policy : Must be medically necessary Comments : Insurance required documentation for physician supervised weight loss attempts for a period of 12 months, a list of co-mobities and a Physc evaluation. I was initially denied because my PCP's office didn't submit the proper documentation. After we re-submitted (on appeal) the originally requested information (I also sent along a 5 page appeal letter for myself) the denial was overturned in two weeks. If you have an insurance company under "MAMSI" check to make sure you don't have an exclusion for non-coverage of this surgery because not all of their companies will cover it. I hear it is going to get much tougher in the future. I started this process in March 2001 and am scheduled for Surgery Aug. 22nd, 2001. It took appox. 6 months but would have been a shorter period if proper documentation had been submitted 1st time around I'm sure.
   — blank first name B.

December 19, 2001
Most insurance companies even HMO's will cover the surgery if it's medically necessary hope this helps
   — blank first name B.