Hiring an attorney

[km30381 2]

my UHC SignatureValue HMO has denied me and my appeal in noW in the hands of Health Care Help Center. If I am denied again I am thinking of getting an attorney that specializes in this Type of claim. It's cheaper than surgery. Has anyone tried this route? Would love to get Some advice

[Alex Brecher 10,516]

If you're going this route, I'd highly recommend attorney Walter Lindstrom Jr..

Here's his contact info:

Walter Lindstrom, Jr.

Lessons Learned: Celebrating 20 Years As A Bariatric Surgery Patient

PRESIDENT & CEO

LINDSTROM OBESITY ADVOCACY

601-C East Palomar Street, #480

Chula Vista, CA 91911

WWW.WLSAPPEALS.COM

Toll Free: 1-877-99-APPEAL (877-992-7732)

Fax: 888-992-1188

Let him know I sent you his way and please do keep us updated on any progress you make!!!

[Donna Fay 4]

If your bmi is really 29 I doubt that insurance would cover it. If itis a covered benefit they usually require bmi of 40 or higher with certain medical problems before approving.

[woo woo 872]

It depends on the circumstances, for example in the case of a band revision.

[Miss Mac 6,262]

Make sure you mention all of the co-morbidities that you can think of. Here is a list from NIH.gov, the National Institute of Health. It helped me that my brother died of a heart attack at age 47 (6'2", 420 pounds) and that my mother died at age 67 of an abdominal aortic anyeurism (5'2", 320 pounds), plus I was pre-diabetic, had high blood pressure, already had a stroke, two knee replacements, gallbladder removal, spinal collapse - everything counts. Here is the list:

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease
• Family history of stroke
• Family history of diabetes
• Family history of heart attacks
• Hyperinsulinemia
• Diabetes
• High blood pressure
• Coronary-artery disease
• Hypertension
• Migraines or headaches directly related to obesity or cranial hypertension
• Congestive heart failure
• Neoplasia
• Dyslipidemia
• Anemia
• Gallbladder disease
• Osteoarthritis
• Degenerative arthritis
• Degenerative disc
• Degenerative joint disease
• Recommended joint replacement from specialist
• Accelerated degenerative joint disease
• Asthma
• Repeated pneumonia
• Repeated pleurisy
• Repeated bronchitis
• Lung restriction
• Gastroesophageal reflex (GERD)
• Excess facial & body hair (Hirsutism)
• Rashes
• Chronic skin infections
• Excess sweating
• Frequent yeast infections
• Urinary stress incontinence
• Menstrual irregularity
• Hormonal abnormalities
• Polycystic ovaries
• Infertility
• Carcinoma (breast, colon, uterine cancer)
• sleep apnea
• Pseudotumor cerebri
• Depression
• Psychological/sexual dysfunction
• Social discrimination
• Premature death in the immediate family
  

[peteyrulz 82]

@@Miss Mac thanks so much for printing the NIH list. My older brother died in 2011 from heart attack at 65. My insurance was completely uninterested in the cause of his death, they only were interested in whether I had HBP, diabetes, or sleep apnea. when I first started this journey 1 yr ago my BMI was 38-39 with depression, GERD, & osteoarthritis. Now my BMI is 41 & I also have HBP. Thanks insurance! I can't help but think if they had approved me IN JUNE that I would be at my goal weight by now AND NOT HAVE HBP. I realize my health is my own doing but this past year has been sssoo stressful with denials and appeals. I wish the there was a standard for insurance to follow the NIH list. My insurance is BCBS federal emp plan; you'd think the feds would use NIH's guidelines, right? Not a chance!

Anyhoo...let me get to my point

I hired Lindstrom Advocacy back in Oct. They're still working my case & thru a comedy of errors at the surgeon's office & OPM it has taken much longer than expected. I have tentative surgery date in May with Nicholson Clinic (Dallas); if my appeal doesn't work then I am throwing in the towel & going to Dallas via self-pay route, it being less expensive bcuz they will fix my hernia & do the sleeve for nominal fee. (I wanted to go to MX but the hubs wouldn't entertain the thought)

I've been mostly happy with Walter & Kelley but sometimes I would not hear from them & I'd get SO FRUSTRATED!!! It's been a long road!!

Sorry to blah blah blah. Fighting insurance is horrendous and it's not usually as drawn out as my case. The Lindstroms are the way to go if you need to appeal. Money well spent!

thanks so much for letting me rant!!!

????????

[Miss Mac 6,262]

It is good to hear that you are going to proceed no matter what. That's determination, girl!

[Bobbe Schu 53]

@@Miss Mac thanks so much for printing the NIH list. My older brother died in 2011 from heart attack at 65. My insurance was completely uninterested in the cause of his death, they only were interested in whether I had HBP, diabetes, or sleep apnea. when I first started this journey 1 yr ago my BMI was 38-39 with depression, GERD, & osteoarthritis. Now my BMI is 41 & I also have HBP. Thanks insurance! I can't help but think if they had approved me IN JUNE that I would be at my goal weight by now AND NOT HAVE HBP. I realize my health is my own doing but this past year has been sssoo stressful with denials and appeals. I wish the there was a standard for insurance to follow the NIH list. My insurance is BCBS federal emp plan; you'd think the feds would use NIH's guidelines, right? Not a chance!

Anyhoo...let me get to my point

I hired Lindstrom Advocacy back in Oct. They're still working my case & thru a comedy of errors at the surgeon's office & OPM it has taken much longer than expected. I have tentative surgery date in May with Nicholson Clinic (Dallas); if my appeal doesn't work then I am throwing in the towel & going to Dallas via self-pay route, it being less expensive bcuz they will fix my hernia & do the sleeve for nominal fee. (I wanted to go to MX but the hubs wouldn't entertain the thought)

I've been mostly happy with Walter & Kelley but sometimes I would not hear from them & I'd get SO FRUSTRATED!!! It's been a long road!!

Sorry to blah blah blah. Fighting insurance is horrendous and it's not usually as drawn out as my case. The Lindstroms are the way to go if you need to appeal. Money well spent!

thanks so much for letting me rant!!!

????????

What's the status of your appeal? Curious since I hired Lindstroms a month ago and haven't heard yet.