The “Plan Administrator” is the legal entity who actually establishes the insurance coverage. Often it is the employer who is making the insurance available to employees, their dependents and/or retirees. But Plan Administrators can also be unions or trusts of varying types (e.g. union representatives and management personnel working in tandem). Employer-based health insurance is either going to be “fully insured” or “self-insured” and that distinction can often be critical to a patient seeking an appeal of a denial of treatment.
We want to help you on your road to better quality of life by getting your insurance denial overturned
Plan administrators have a “fiduciary duty” to manage the plan in a way that is in the best interests of everyone, including patients who are denied treatment. While the plan administrator might delegate some of those responsibilities to other entities or organizations (usually called claims administrators or third-party administrators), most frequently the Plan Administrator retains the “final word” on whether claims get approved and they have to use that power wisely, even if it sometimes means using their discretion to overturn a denial.
We help many patients fighting denials to seek a review by the Plan Administrator and this often leads to treatment approvals that have been denied by the insurance company, administrator and even an external reviewer. The Plan is required to ensure a full and fair review of denied claims and is able to approve cases where others don’t have the power. We analyze every situation and understand when the Plan might become the patient’s best chance of winning and, like the IRO process, we are constantly setting your case up to be in the best possible position to get approved by the Plan itself. Doing that makes the difference between you having the surgery or treatment you need or not having it.
601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199
Oh my goodness!!!! Kelley – I can’t say thank you enough!!!! Thank you, thank you, thank you!!!! This is the BEST news ever. I am SO HAPPY! Thank you! Please tell me where/how I can leave you a review. Both you and Mr. Lindstrom went so above and beyond my highest hopes. I am so incredibly thankful. You guys are the best! Calling now to schedule the surgery!!!
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 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!
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!
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!
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 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.
Thank you so much Kelley (and Walter!). I so appreciate all you have done for me!!!