Question:
My insurance company, Mamsi, is asking for more information.

I have been denied several times since November due to an exclusion stating that surgical or medical treatment of obesity or treatment for weight loss or control is not a covered benefit. Finally, after testifying in MD to help pass the bill, having a senator write a letter on my behalf, appearing on the local news, and writing to the president of the company, Mamsi finally sent me a letter asking for: 1.) A recent physical, including weight, BMI, and comorbidities; 2.) Documentation of a recent 6-month doctor supervised diet; 3.) Psychological evaluation of my current condition and ability to follow post-operative guidelines. After submitting all of this information, what do you think my chances are. I do not have diabetes, but I have borderline high blood pressure, GERD, depression, chronic fatigue, back pain, shortness of breath, and edema. There is a strong family history of hypertension and diabetes. Do you think I stand a chance? Any suggestions of anything else I can include.    — Jackie L. (posted on August 6, 2001)

August 6, 2001
I also have a MAMSI Plan (MD IPA). I live in Va. and we have a law similar to the one that was recently passing Md. My plan does not have an exclusion, but this has to be pre-authorized by them before you can do anything. It states that they want a 12 month period of physician supervised weight loss attempts (does not say previous), a physc eval, you have to have a physical, documented co-morbities, documented medications and your documented BMI. I was initially denied because my PCP did not send in the proper documented weight loss attempts. (its a long story regarding my PCP) However, when the dr. did the appeal letter and supplied everything they requested, my denial was overturned within 2 weeks. I have to believe that it has been a little easier for me than some others with MAMSI because I am a federal employee and the exclusion just was not there. In any event, just make sure you have all the documentation they want and then some. I submitted a five page appeal letter on my own behalf. Good luck and I wish you the best....
   — Betty M.