Walter Lindstrom

My bad! I probably need to change my signature because I thought it was there automatically. Thanks for letting me know. The telephone number is 1-877-992-7732. You will speak with Kelley, my better half, partner and wife of nearly 39 years. She’s talking to someone now so leave a VM message if she can’t answer and she will call you ASAP. Thanks! Walter

I’m sorry to hear about your issues. I hope you have not yet exhausted your appeal rights. I urge you to call us for an assessment of how we are able to help. 25 years of advocacy and thousands of appeals later, we know what we are doing 👍🏻 Ask around the BariatricPal site.

I'm sorry you're going through this. I can certainly help interpret the language (being an attorney and patient advocate who has handled over 10,000 bariatric surgery appeals over the last 25 years or so). Sorry to say I am pretty sure this Rider is an attempt to exclude all bariatric surgery that may have previously been covered. If you'd like to contact our office for an analysis I'd love to sift through what you're dealing with so you know your coverage from the outset. As mentioned by other folks responding to your question, I would want to see the existing coverage booklet (as a PDF) that this rider is attached to so we can piece together for you what's going on. You are correct in being cautious about moving forward and our office is here to help. Call us at 1-877-992-7732 and we can discuss this in detail - - - it's going to be a complicated puzzle to put together, but nothing we haven't been doing for a couple of decades!

BCBSTX offers many plans depending on the employer type (large or small group, individual, state plan, unions, etc.) - some cover, many don't (sorry). Since you haven't had a preauthorization request sent to them yet, there is nothing that's been denied. This gives you time to locate your Certificate of Coverage or Summary Plan Description - the long booklet (usually 100 plus pages and not to be confused with a "Summary of Benefits and Coverage") so you can look for yourself as to what is / is not covered. We're coming up to the end of the year so you ought to see if your benefits change to a new payer or plan type on 1/1/2021 if you don't have coverage. Contact us if you want some free help with the process - Kelley will be happy to guide you in the hope it leads to an approval. Good luck!

We've successfully helped several GHI members get revisions so please be optimistic - BTW, whether or not you regain weight is IRRELEVANT since changing eating patterns due to severe GERD is not only common, but often a necessary way people can tolerate ANYTHING! Let us know if you're submission is denied before anyone at the doc's office does something that might hurt your chances of being approved and GOOD LUCK! GERD really sucks so hopefully you get approved without a problem.

I am excited to announce our participation in the 5th Annual National Obesity Care Week (NOCW) which takes place September 15th to 21st and I am honored that our office is considered a Champion supporting this powerful national awareness campaign dedicated to making sure access to comprehensive obesity care is available for anyone affected by obesity. Today, more than 93 million adult Americans are living with obesity. Many do not know obesity is a disease and that their healthcare provider can help them with weight-loss and maintenance. Others do not have insurance coverage to help them pay for these healthcare options or they have to FIGHT just to access coverage they paid premiums to have! Now, more than ever, people affected by obesity as well as healthcare professionals and policy makers and all persons who care about this injustice must pledge their support for ACCESS TO CARE WITHOUT BARRIERS. Alongside the founding partners – the Obesity Action Coalition (OAC), the American Society for Metabolic and Bariatric Surgery (ASMBS), the Obesity Medicine Association (OMA), The Obesity Society (TOS), and Strategies to Overcome and Prevent Obesity Alliance (STOP) – Lindstrom Obesity Advocacy believes that everyone should have access to obesity care that is not limited by a person’s size, weight or economic status and we've been fighting for this cause for over 23 years! Please visit ObesityCareWeek.org/Action to pledge your support as well.

So happy and honored that today is our 23rd anniversary helping #patients fight insurers denying necessary care. Looking back, I see how far we've come and that gives me hope. Looking forward, I know we have a ways to go but we will continue to battle!

Hi Butterfly512, We handle hundreds of these kinds of denials (band conversion cases) so I wanted to share something before you went to surgeons thinking you might have to talk them out of a "required" six-month diet. Remember, despite what you might be told, there is no evidence-based medicine to support these bogus 6-month diets and the society of bariatric surgeons has soundly rejected the concept of insurer requirements like this. However it is quite possible that isn't even relevant in your case if you are having your band removed (with a conversion to a new procedure) because of a complication . While most people only think of band complications as being a flipped port or the band slipping or eroding, there are other complications we see every day, most of which result in stalled weight loss, weight gain, severe reflux and other serious problems. Often overlooked, even by surgical practices whose dieticians are often trying to paint we patients as the ones to blame if a surgery "fails", is a recognized complication called "band intolerance." That means, in essence, you cannot get it adjusted in the "green zone" so you're either too tight which results in severe reflux, regurgitation, vomiting, and pain (sometimes) or you are open and getting no satiety or restriction and can eat anything. Either way is bad but having a band too tight is often something people try to muddle through - often by eating softer, usually higher calorie foods because they go down easier than the dense proteins we are supposed to eat. When complications are present and your band has to be removed because there is no other way of treating your symptoms, there is no medical reason to be forced to undergo a 6 month diet. Think about it and you know the answer to this: how is a diet going to help alleviate something that can only be fixed surgically? Sadly too many bariatric practices simply have knee-jerk reactions about these diet programs which make no sense - they do it because they have allowed insurance companies to make these medical decisions. Hopefully this information helps you interview surgeons in your area and gives you some "ammunition" if someone in their office (or the surgeon themselves) tries to convince you that going on the dreaded six-month diet is necessary. And feel free to call us at 877-992-7732 if we can help in any way, even if you haven't had a request sent to your insurer. Good luck! For Patients' Sakes - Drive The Bus!

That's great news! Congratulations! We hope you have a completely BORING and UNEVENTFUL surgery - the best kind to have - followed by an easy recovery as you move toward a healthier YOU! Best, Walter

Ahhh - - that's the New Mexico Medicaid plan offered through BCBS New Mexico. They will undoubtedly have a separate set of "rules" which might differ from "traditional" BCBSNM medical criteria. Your surgeon's office (Prebyterian perhaps?) should be able to walk you through that specific process and time frames involved. Good luck!

Since these are independent members of the national "Blue Cross and Blue Shield Association" it's unfortunate but not all "Blue Cross Blue Shield" companies treat bariatric surgery in the same way. Some are great - others? Not so much. Let us know which specific company you're with and where you are located so you can get the right answer, FOR YOU. Here is a link that identifies all the BCBS Association members in case it helps anyone: BCSB Companies and Licensees

Exactly! It's a medical decision which should be reserved for physicians. However, I hope bariatric programs don't make mandatory diets a requirement of their programs as a knee-jerk reaction to insurer demands - even when insurers don't "demand"! Why? Because there is no evidence-based medicine to support mandatory diets! Here is more information to help: ASMBS Position Statement On Insurer-Mandated Pre-Surgery Weight Loss Requirements

Hi! Stay optimistic but be prepared for UHC doing the wrong thing. The peer to peer process isn't often a great process for patients - it often starts with the UHC medical director and your surgeon having trouble connecting on the phone to even discuss things. So don't let that drag out before you act because even if/when they do connect your surgeon may be dealing with a UHC medical director who simply doesn't have the authority (or the expertise) to consider your individual circumstance. So be proactive and take control - Your best shot at overturning the denial may be the patient appeal process and you don't need to wait for the peer-to-peer to get started on an appeal. Your bariatric provider may tell you to wait for the peer to peer but you'll feel better if you're doing something proactive and know you're learning about the process. And if the peer-to-peer is successful (HOPEFULLY) than you're good to go and you've lost nothing. But you may want to call us to help walk you through things - we do a lot of UHC band removal/conversion appeals and we know their process better than anyone. Hope this helps and good luck!

I understand your anxiety but you should go to your appointment focused on how surgery can help you NOW because of your health NOW. I'm linking a blog post I wrote which should give you some comfort (I hope). Aetna has played this sad, pathetic game for quite some time (as have many other payers) but you can't stress over it - just take care of yourself - prepare for the journey - and know that if they say "No" it isn't the end of the world. That answer isn't final - you can fight and you can win. Hopefully they do the right thing right away. Good luck and let me know if we can help. Aetna's "Two Year History" Denial Overturned

It's important not to get caught up in a specific number - you haven't gained excessively and you have changed behaviors. We stress that your insurance company - whoever they are - is NOT THE BOSS OF YOU when it comes to pre-surgery diet programs. You Gained Weight During Your Pre-Op Diet . . . Now What? Good luck!