Should I fire my lawyer?

Paparazzi · November 19, 2005

I hired an internet lawyer last February when I was denied by Anthem BCBS as experimental. I was rejected for the next two appeals (I was told there were two appeals..I only got a notice for one). In June I went ahead and went selfpay. Now I find out that my insurance company started approving the lap-band in mid June. I emailed my "attorney" and he said that they would file another appeal. Should I trust him? I'm worried that come the first of year that the insurance company might make another change to the worse, if something isn't done soon.

Cathy

princess_n_thep · November 19, 2005

Why would you hire an internet lawyer to fight insurance? Are you saying you found the "lawyer" over the internet? Have you had consult with this lawyer?

Paparazzi · November 20, 2005

This guy is very popular on the obesity forums for fighting insurance companies and winning. I've talked to him on the phone but not in person. He was even recomended by my doc. I don't want to mention him by name. There are three lawyers that I know of that specialize in this area.

Alexandra · November 20, 2005

Cathy, we can't advise you on whether your attorney is doing a good job. How much do you know about your insurance policy? How much do you know about the appeal process and how yours were mounted? Did you have any input into the paperwork? Have you spoken with the insurance carrier directly?

It's always worth appealing but you shouldn't let anyone do it "for" you without reading over every word yourself. Your doctors have to be a part of it too. If your state has regulations protecting insurance consumers then you should know what they are.

In general, if you self-paid for something you can put in a claim for reimbursement. Most carriers require surgical pre-approval, though, unless you have an indemnity-type plan (PPO or other non-HMO coverage). So if you have a managed-care plan and did not get pre-approval for the surgery, there are likely to be stiff penalties for that even if they do ultimately decide it should have been covered. So it may or may not be worth continuing to pay an attorney, or even putting in more time and effort now to get reimbursement.

Good luck with whatever you decide.

princess_n_thep · November 20, 2005

I think if the attorney did well for you the first two times, why not let him try again then and see what happens. But what about doing your own leg work and tying it yourself? May be cheaper. But I do understand that sometimes it is best to let someone else do all the dirty work. Like selling a house... I would never try and do For Sale By Owner again. What a nightmare. At first I didn't want to hire a realtor and pay them for what I could do on my own. Boy, was I mistaken. I am so much more stress free with a realtor I trust.

My advice is... if you trust your attorney and you like what services he has done thus far, then keep him. If you don't, then don't. Sorry, it is vague advise.

Paparazzi · November 22, 2005

I guess I'll give him a little more time, because I haven't a clue where to start. The insurance lady from the doctor's office said that I had a good chance of getting at least some of my money back. She's the one that let me know that the company had started covering the lap-band. She even told me where to find the new policy on their website. Thanks everyone

Cathy

CCBSTX · December 10, 2005

Not sure how much you are paying for this attorney. I would gather my paperwork (first denial, first appeals, etc). Then, I would try to file a claim for the full amount. Attach a note, from the surgeon, stating how the lapband is not experimental (FDA approved, statistics, etc). Keep copies of everything and see what they say. An attorney, could do this, if you've already paid.

WannaBeHealthy · December 11, 2005

Give your lawyer another chance.

I thin I worked with the same lawyer. I found him on the obesity sites and he was also recommended by some of my Chat buddies that I have met on these sites. My insurance denied. And the attorney helped my with appeals to insurance which were upheld. The attorney then helped me with an appeal with the state. The state then overturned the insurance company and it looks like all systems are GO! I have a feeling that we are talking about the same attorney. I would highly recommend him. Give him a chance.