Exclusions within the contract language are often the most frustrating type of denial faced by a patient seeking insurance approval. Thoughts such as “How can they not cover this surgery if my doctors all say it is medically necessary?” run through your head. Those are not unreasonable thoughts. Unfortunately, too many patients simply walk away from even trying to get approved because they think “It isn’t worth it” or “I don’t stand a chance. “NOT TRUE!
CALL US TO DISCUSS THE EXCLUSION YOU HAVE
We will tell you if we don’t think you should get us involved or why we won’t take on a particular exclusion. BUT there are a great many occasions where we can fight those fights and WIN those fights for the courageous patient who refuses to take “NO” for an answer.
Victories over exclusions can be achieved for various reasons such as poor drafting of the exclusion or the company’s failures to follow certain regulations, just to name a couple. However no fight can even start unless you and your surgeon’s office work together to submit the pre-authorization request so you can at least get the insurance company to deny you in writing. That written denial triggers your right to appeal and is what’s needed to start the FIGHT.
601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199
Thank you so much for your email. I honestly didn’t think that things would change with this appeal but it was worth trying. Thank you for all of your hard work and follow up. I cannot tell you how much I appreciate everything that you have done for me. It is amazing to know that there are people in your corner.All the best to you and your clients.
Hello Walter and Kelley,
I wanted to send a huge THANK YOU to you both, as well as to your team! Everything happened very quickly after my appeal hearing on June 26th, and I had my bypass surgery on July 10th !! And I went back to work on Monday July 15th, so its all been a whirlwind! I am feeling great, the weight is coming off, and I am starting to really feel like I am getting back to normal (well my new normal that is).
This would not have happened without your help, and I am forever grateful for all the work you all did to help me. I will certainly recommend you all to anyone going through the same struggle as I did. You all are just wonderful and made the process very easy. I just want you all to know how much I appreciate all your help!
Thank you. I’m so emotional right now! You guys are helping me change my life. When everyone told me that I would not be approved,you guys made me feel confident that there was a way. I am forever grateful.
After my initial denial by Cigna I hired Lindstrom Obesity Advocacy to handle my appeals and am happy to say that my denials were overturned on independent review. Kelley was wonderful, always available to me and always on top of the appeals at every turn. She kept me informed of any progress as soon as it developed. She really seems to care about her clients. I highly recommend using them. My first denial was in June and the denials were overturned in August on independent review. My surgeon’s office commented on how fast the process was compared to the experience of others in their office. . . . It was the best money I ever spent and I am over the moon that this worked out for me. My recommendation is don’t wait to contact them. I contacted them immediately after I got my first denial and they handled the rest. So that’s my two cents!
I had to go to external review but I’m now APPROVED for revision from Band to RNY!!!! I can’t say enough positive things about Kelley & Walter at Lindstrom Obesity Advocacy. If you find yourself stuck with denials from insurance companies, I highly recommend them!
I want to almost cry after seeing what you have done and going to the ends of the earth in defending my efforts and struggles. I want to thank you so much (the both of you) for all of your efforts. It has really meant the world to me.
Oh my God!
Thank You so much! It has been wonderful working with you.
Thank you so much Kelley (and Walter!). I so appreciate all you have done for me!!!
I’m so excited to finally be able to move on!
Thank you very much for your quick reply and the helpful tips on what should be done. I will proceed as you recommended and contact you again should I need additional assistance. I appreciate knowing that there is someone out there that is willing to fight to help me have a better life. You need to know how much just just the words in your email mean to me. Thanks again and have a wonderful new year!wing that there is someone out there that is willing to fight to help me have a better life. You need to know how much just just the words in your email mean to me. Thanks again and have a wonderful new year!
Didn't Have To Retain Us!
Thank You, so much. I cannot express my gratitude for what you and
Walter do. It is absolutely overwhelming to have someone that has your
back and knows exactly what avenues to take to seek approval. I know
that it is not always successful but, I am so grateful for the outcome.
I spoke with my doctors office yesterday and my surgery is scheduled for
December 12. Merry Christmas to me!