Has anyone hired either of the two attorneys that specialize in Obesity related insurance appeals? I would just like to hear some other experience on this matter. I was denied by UHC on 01/23 and am waiting for my medical records and highly considering hiring an attorney.

I too am in process of determining which way to go after UHC for a 2nd Appeal. I had my 1st letter for appeal denial yesterday. This is so difficult. I have approval for removal of my lap-band and denial for the replacement of the defective component. Have other experence in 2nd appeals?

Has anyone hired either of the two attorneys that specialize in Obesity related insurance appeals? I would just like to hear some other experience on this matter. I was denied by UHC on 01/23 and am waiting for my medical records and highly considering hiring an attorney.

I'll ask my office manager if we have had any patients use a specific attorney, but I know Walter Lindstrom is highly regarded.

I did not use, but contacted Walter Lindstrom. I called and told them my situation, and they were honest with me. I had a company that had NEVER paid for the band. They had fought my insurance and lost a few times. They refused to take my case, Kelly (walters wife) told me that they had to look at themselves everyday and wanted to be able to do that in good conscience. They were honest with me, I was upset but at least I wasn't out a bunch of money. I continued to fight and eventually won. The first person I called was Kelly, she was so happy for me. They are nice, honest and walter has had WLS himself so they know how it is to fight for it. ~Mandy

Mandy,

Thanks for the insight. It was very helpful. I wish others here would also post their recommendations.

Like I said I didn't use them, but they were honest, sweet and actually remembered me several months later. They are VERY hard to get a hold of, but if you leave a message someone will eventually call you back. I think it took over a week for them to return my call. Most of your questions can be answered on their site. ~Mandy

Hi,

i have Medicaid and they denied me for lap band but approved me for gastric bypass---which i didn't want.

Because of my low income, i was able to get an attorney and i asked for an appeal. They overturned their original denial on the phone!

i did most of the research, paper work etc. myself....cuz attorney didn't know about it.

cal

If your insurance denies the band but approves another form of weightloss surgery there is a packet from Inamed that helps with that kind of appeal. There is also a packet that helps when it is deemed experimental. ~Mandy

I got a form from my surgeon to apply for a FREE attorney (Walter Lindstrom)to assist with the appeal! I would've paid for one but free is even better. I'm a pessimist so we'll see if it is truly free and how well it works. I am 38 BMI with United Healthcare and got turned down flat with no explaination in the denial letter. It is a covered benefit under my husband's plan. I have never prayed so much in my life for something! My husband and I decided that if I can't get insurance to pay for it, I can't do it. Even though I could charge the operation, I'm more afriad of complicaitons. The thought of complications wiping out our savings (we have 3 kids) is just too risky for us.

Waiting on this process has been overwhelming. It's really all I think of--am I going crazy?

Maybe the surgeon pays for Lindstroms services? I know some surgeons work with the lawyers enough that they get a really reduced rate to send their patients there. I know that Walter does not work for free, he is the one I talked to and his charges are listed on his website. ~Mandy

Spectacularone, You can do this. It seems like an up-hill fight but you can . . . fight. After all it is your health and quality of life and you are only 2 BMI points from auto approval. UHC makes everyone wait because they can . . it's been two months this 2nd time for my replacement lap-band surgery and a 2nd appeal process for me. By the time UHC makes you wait, you may already be at 40 BMI. Now while that is not the ideal way to make it happen, it is what stress does to most of us. So if it is what happens, it's not if a lap-band is in your future but WHEN . . . am I right? I really do understand about what you said. IT can be completely overwhelming . . . but do not let UHC do that to you. . . they don't care about your health only their policy. They will make you appeal because of that policy and their baseline requirements, it's not personal. So what do you do to not go crazy . . . know that it's the Lord who is building your faith in Him so you can know He is in control and He loves you . He is going before you even now to give you a brighter future. It will happen and soon. So even if you do stress-up to a BMI of 40, you will have the operation and then be a normal BMI of 24. . . it's just time. So in the mean time, love your children and DH who need you to be content.

Ok,

I have contacted Walter and Kelly Lindstrom paying/asking them formally to take my case. They are reviewing the documentation now for my 2nd UHC Appeal for the replacement of my defective/leaking 34.5 month old Inamed Vanguard Lap-band. UHC paid for the first band, my leak occured 3Nov06, took until january 23rd to submit to UHC for the limited (the port is functioning and in great shape) replacement, found out my policy changed on 1 January, 2007 so they only approved the removal of something (did not say the whole system or not), I did my 1st appeal on grounds of pre-exsisting condition and timeing of occurance, so now the Linstrom (hopefully) will sucessed where I have not.

I have gained 25.5 pounds in 4.5 months dealing with this stress of lossing the band's fuction, testing, medical reviews, and delays in approval; but, it's ok cause I will get it off again with my new lap-band. But the difference is that this time, I will get to my 24 BMI goal; no more playing with the process. It's going to come off ASAP after I get my new lap-band. . . AMEN!

S-o-o-o let's :cheer2: for the Lindstroms! Make UHC pay. . . . please!!!:faint:

Judy, have you worked with Kelly? She is sooooo sweet and supportive. If you have not had the pleasure of working with her, you are in for a treat. She will be open, honest and upfront with you. I recommend them to anyone that asks. The fact that they refused to take my money and told me that they could not help me, really gave me faith in them. Actually it restored my faith in my fellow human being. I was at the point of believing that all people wanted to do was better their own life and couldn't care less about mine, Walter and Kelly not only refused my money, but genuinely wished me the best and ask me to let them know if I was ever managed to get approved. ~Mandy

I don't think the surgeon pays for the attorney. It was Lindstrom himself that told me there was a program that would pay for his fees. I haven't been "approved" yet to have the legal fees paid for. I have applied and my Dr.'s office said it's through the lap band maker inamed??

Anyway, I don't beleive anything until I see it. I'd be willing to pay for the attorney if I need to.

I think it's so awesome that there are people that are going through exactly what I am--it's nice to gain insight and support. Thanks Jellybelly for you words of support and I'll hope for a good outcome for you as well.

I talked to Don Mills at Inamed, he is the king of all things Inamed related. He can answer most questions regarding insurance assistance. There wasn't a program like that when I was fighting but that was 2 years ago. I did get covered, it just took a huge fight. It was worth every moment and all the stress. ~Mandy

I am currently appealing my denial through Kelly and Walter Lindstrom. From what Kelly told me, the makers of the lap-band (Inamed?) believed in their product enough to "fund" (for lack of a better word) people who qualified for the procedure by paying for the legal fees. I was originally denied by Humana because of lack of a 6 month diet. After completing the diet I was denied because I had not appealed within a 30 day time period. Each time Kelly would call/e-mail me and say, "No stress, if they do blah, blah, blah, we will do blah, blah, blah. She always has a game plan and is always thinking. She instructed the surgeons office to resubmit the information to the insurance company and told me to wait the 30 some odd days to receive information. If I was denied again she said she would immediately appeal. On Tuesday the surgeons office contacted me and said the insurance company said I had 3 days to get them an "official" weight and bmi. On Wednesday I was @ my pc doctor's office who faxed that info to the surgeons office. Maybe this is good news and Humana is finally doing what they are paid for.