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Exclusion for “One Surgery Per Lifetime”?!? Not So Fast…..
Posted Nov 13 2018 by Walter Lindstrom in Appeal Case Studies, Bariatric Appeals, Bariatric Insurance Issues, Walter's Blog with 7 Comments
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?????
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BIG NEWS! Several insurers are going to REMOVE pre-surgery supervised diet requirements
Posted Nov 6 2018 by Walter Lindstrom in Walter's Blog
The Health Care Service Corporation (BCBS IL, TX, MT, OK, NM) Bariatric Surgery Medical Policy no. SURG716.003 effective February 1, 2019 is, believe it or not, good for bariatric patients. HCSC is eliminating the requirement that patients engage in supervised weight loss programs prior to surgery.
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Spooky Tales from the Darkside of Bariatric Surgery Appeals
Posted Oct 30 2018 by Walter Lindstrom in Walter's Blog
“Please understand that we are your health insurance plan – – we have special training in providing misinformation, acting incompetently, being argumentative and showing a complete lack of compassion or interest in your health. Now having said that . . . . . .How Can I Not Help You Today?”
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It’s August! Did your bariatric surgery coverage change in July?
Posted Aug 9 2018 by Walter Lindstrom in Walter's Blog
Did your bariatric surgery coverage change in July?
Of far greater frequency and tragedy is the patient who had coverage only to find out he or she lost it when their employer renewed its insurance with a new company. This can happen even when the insurance company itself remains the same because often the scope of coverage changed.
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