Comments on: please help I have an exclusion http://www.obesity-surgery.bseulf.org/2006/03/21/please-help-i-have-an-exclusion/ Fri, 16 May 2008 07:56:20 +0000 http://wordpress.org/?v=2.2.1 By: Jamey Lancaster http://www.obesity-surgery.bseulf.org/2006/03/21/please-help-i-have-an-exclusion/#comment-3267 Jamey Lancaster Tue, 21 Mar 2006 16:15:35 +0000 http://www.obesity-surgery.bseulf.org/2006/03/21/please-help-i-have-an-exclusion/#comment-3267 Per book it states Confinement,treatment, services or supplies rendered for weight reduction or morbid obesity treatment, including surgical procedures such as gastric stapling. Then I had an enclosed Amendment that states. Confinement, treatment, services or supplies rendered for weight reduction or Morbid obesity treatment, including surgical procedures, except for the coverage specifically outlined in the section titled Hospital and Institutional Services. UNDER Hospital and Institutional Services It says: Inpatient Hospital Services include room and board, general nursing care, meals, special diets when MEDICALLY Necessary, Use of operating room and related facilities and use of Intensive care unit and services. <!--more--> When I called and spoke to a Rep she told me that my PCP has to first request with 12months previous diet attempts and a psych evaluation. Then it may be considered. So what do you think? Stats 5 year med records of attempt weight loss age 30 h 5-5 Weight 379 Currently on Phen and Antidepress Phen is not working Ins MAMSI MDIPA Back Pain, PCOD, MOB, Joint PAIN, snorring I am going to make an appointment for sleep apnea I am starting WW again on 07.29.03 I am going to see a nutritionalist in Sept This is a Group Covered Service ( I work for Mamsi Just started) It is in MARYLAND (laws don't work for group ins) Previous attempts for surgery but ins cancelled with exclusion last min. This is my third attempt with diffrent ins. Per book it states Confinement,treatment, services or supplies
rendered for weight reduction or morbid obesity treatment, including
surgical procedures such as gastric stapling.

Then I had an enclosed Amendment that states. Confinement, treatment,
services or supplies rendered for weight reduction or Morbid obesity
treatment, including surgical procedures, except for the coverage
specifically outlined in the section titled Hospital and
Institutional Services.

UNDER Hospital and Institutional Services It says: Inpatient Hospital
Services include room and board, general nursing care, meals, special
diets when MEDICALLY Necessary, Use of operating room and related
facilities and use of Intensive care unit and services.


When I called and spoke to a Rep she told me that my PCP has to first
request with 12months previous diet attempts and a psych evaluation.
Then it may be considered. So what do you think?

Stats
5 year med records of attempt weight loss
age 30
h 5-5
Weight 379
Currently on Phen and Antidepress Phen is not working
Ins MAMSI MDIPA
Back Pain, PCOD, MOB, Joint PAIN, snorring
I am going to make an appointment for sleep apnea
I am starting WW again on 07.29.03
I am going to see a nutritionalist in Sept
This is a Group Covered Service ( I work for Mamsi Just started)
It is in MARYLAND (laws don’t work for group ins)
Previous attempts for surgery but ins cancelled with exclusion last
min. This is my third attempt with diffrent ins.

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