- WHO ARE WE?
- WHY INSURERS DENY
- GET STARTED!
- THE APPEAL PROCESS
- WALTER’S BLOGA blog authored by Walter Lindstrom, President of Lindstrom Obesity Advocacy, focusing primarily on bariatric surgery and obesity treatment insurance issues.
There are many challenges in cases like these. Can it really be established that there IS a “complication” in a case where there is no erosion, slip, obstruction, stricture or other identifiable “technical defect” in the original procedure? Shouldn’t this be challenged based on simple “fairness”? After all, insurers don’t limit members to one cancer treatment – one knee replacement surgery – one diabetes medication, do they? ISN’T THIS PLAIN OLD DISCRIMINATION?????
There can be a BIG DIFFERENCE between an “external” review and an “independent review.” WHY IS THAT DIFFERENCE SO IMPORTANT? Many times a bariatric surgery appeal is sent by your insurance plan to an “external peer reviewer” who often comes back with another denial. …
At the time her doctor submitted the preauthorization request for a RNY gastric bypass, this 43 year old female patient had already completed a supervised diet and received her nutritional, psychological and medical clearances . . . just like Aetna’s medical policy (0157) requires. Easy …