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. 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.
I WAS APPPPPPPPPPROVED!!!!!!!! The IRO overturned the denial!!!!!!!!!!!!!!!!!!!! I just got home from work and there was a letter. I’m a big baby right now over this. I’m going to run out of tissues, lol. I will forward you this letter first thing in the morning and will call your office as well! I can not thank you ALL enough. WOW!!!!
I have done nothing but cry my eyes out for the last 30 minutes!!! I can’t even begin to tell you how grateful we are for the two of you. I have already passed your information on even before this approval came through because I could tell how genuine you are. You’re doing good work. I can’t thank you enough!!! I really think you just helped save my husband’s life, and obviously I want him here with me for as long as I can have him. You two are truly blessings to us. I know your words of encouragement mean a lot to [my husband]. Thank you. Thank you. Thank you.
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!
Wishing you and Walter a GREAT 2015 also. You both gave me the tool I needed to get my life back – without the both of you (and your AMAZING team) working on my case I cannot say that I would be where I am today. I APPRECIATE all you did and continue to do for people like me. I continue to spread the word about your advocacy group and all you can help other accomplish if they only make that first call or send that first email like I did. I hope others I have talked to have taken advantage of the help and guidance you can provide. I will sing your praises to anyone who will listen – especially if they have a denial for surgery.
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.
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.
Thank you so much for all your hard work. I don’t have words to express my gratitude for all you and Kelley have done for me! I agree I felt as though the case might be doomed! So excited to move forward! Again, I am beyond thankful for all you have done!
Thank you so much Kelley (and Walter!). I so appreciate all you have done for me!!!