Hello~ someone please help me

r2ht4u · January 17, 2006

Hi..I'm Donna from Frederick,Maryland I guess I need someone to kinda take me under there wing and show me the steps...where to start. I have Optimum Choice INC (MAMSI) I called them and they told me over the phone the lapband & GBS is EXCLUDED! Now what..........please:help: me:faint: :cry

Alexandra · January 17, 2006

Hi Donna,

You need to get more information. You might have been speaking to some robotic CSR who parrots general information. Did they tell you WHY it was excluded? Is this your employer's exclusion or part of a standard plan? Is it excluded for everyone even in the presence of a diagnosis of morbid obesity? Is all obesity treatment excluded or just surgery?

You should locate your contract and find the specific language addressing the exclusion. If it's an employer exclusion, then your employer may be able to make an exception or change the contract (if they are so inclined). If it's a standard plan you may be able to appeal to a state review board.

It's too early to give up, find out more and see what the next step is. Good luck!!

r2ht4u · January 17, 2006

It's too early to give up................WOW thank you for that, You know I just called the insurance comp AGAIN and they told me it was covered after you did the 6months of weight management etc WOOHOOO Geee I hope it all works out! Wish me luck~Doctors apt in the morning!

Jessiebear · January 17, 2006

:whoo: :whoo: :whoo: :whoo: :whoo:

Good Luck!!!!

r2ht4u · January 17, 2006

Thank you...Doctor called had to make another apt for the 30th cant wait to see the next step...was wondering Jessiebear is that 3lbs in a year you lost?

Chicken · January 20, 2006

Don't give up! I tried to have grastric bypass 3 years ago and was turned down because it was an exclusion by my insurance. I tried again in 5/05 and was told again that it was an exclusion after my family dr. sent in a request, then my surgeon sent in my history and the lap band was accepted because of medical reasons. I had to give a 5-7 year diet tries, weight history, my medical history and family medical history but PTL it was finially approved! So hang in there and keep trying.