- 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.
Imagine this scene: Your body mass index is well above 40, you have several obesity-related diseases and you’ve tried and failed numerous diets over many years. YOU ARE FINALLY READY to consider bariatric surgery. You medically qualify for bariatric surgery and you are committed to …
Insurance payers are getting more aggressive denying all forms of treatment for all sorts of reasons. Claims of long-time FDA approved devices or well-accepted modes of surgical access are often being routinely denied as suddenly “experimental, investigational or unproven.” Treatment modalities and surgical interventions accepted by specialists are suddenly “not medically necessary” or they “do not meet payer coverage criteria.” The question is “How do patients and providers effectively challenge these unreasonable bars to treatment access?”
The Regence Group (which includes several Blue Cross Blue Shield affiliates in the states of Washington, Oregon, Idaho and Utah) has recently made 2 changes to their bariatric surgery medical policy no. 58 in the last couple of months. Effective September 1, 2012, Regence (FINALLY!) …