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
Mrs. Lindstrom, Thank you for the great news.I will call my surgeon’s office to work out a schedule. I am grateful that they referred me to your office and I will recommend you to anyone who needs assistance.I believe that this result was achieved only through the advocacy of your firm. Thank you very much for all of your effort.
I am absolutely over the moon excited right now. I finished my 6 months supervised diet/nutrition with my surgeon’s office back in April, but I was denied when it was submitted to insurance, despite having a BMI of 42 and GERD (they denied it and said GERD wasn’t one of their approved co-morbidities, and my insurance plan requires a co-morbidity regardless of BMI). I immediately contacted Lindstrom Obesity Advocacy and began the appeals process with them. Within a month of them sending in my (wonderfully written) appeal letter, I just received a call to let me know that United has approved me for surgery and has provided their office with the approval and authorization number. . . . I am beyond excited! This is actually happening!!
Thank you so very much for this wonderful letter of request. I honestly regret not contacting you when I was initially denied. I am just flabbergasted at the detail and the evidence based references provided. WOW!!! I deeply regret not knowing you existed. You really take the WORD advocacy to a whole new MEANING. Words cannot describe how satisfied I am to see such documentation and how thankful I am for your help. Thank you!
OMG! I was NOT expecting this! I tried to call you when I received your message, but I think your office was already closed for the day. I will call back tomorrow just to say THANKS in person! Looks like Christmas came early! I will contact the doctor’s office tomorrow to schedule the surgery as quickly as possible…Words cannot express how thankful I am for your help! You have been such a pleasure to work with! I will make sure my surgeon and his office staff know how helpful you have been so they can be sure to recommend you to others that might be struggling with the same problem.
You are the best Thanks again for everything you did. I know for sure I never could have accomplished this on my own!
I just called my doctor’s office and the scheduler was absolutely amazed the denial got overturned! She said she has done tons of appeals for patients and it doesn’t ever usually work out this way. I can’t speak highly enough of Kelley and the Lindstrom group.
Dear Walter and Kelley: Today is the 1-year anniversary of my lap-band surgery. To date, I have lost 67 pounds and I am in the best shape of my life – I don’t remember a time that I weighed as little as I do now, not even in high school. The time you spent appealing my case was invaluable and absolutely life-changing for me, and I just want to let you know how very much I appreciate all the work you put into it on my behalf. I am thankful beyond words! God bless 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!
I just wanted to update you and let you know how much we appreciated your help in getting us this approval. My wife had the procedure done in October and has been doing great. Already she has lost weight and her sugar counts are stable and doing fine. The Doctor has taken her off Insulin and High Blood Pressure medicine as a result. She feels real good on the progress she made so far. Once again, thanks for all your help.
I was turned down by my insurance company because they said I was not fat enough for long enough. I hired the Lindstrom group and they were great. I was approved a week after they submitted my appeal….it was so worth it. They are the nicest people. I do not regret hiring them. I just wish I did it sooner.
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!