Denied Twice Finally Approved External Review!

[fancynan39 0]

I am new to this forum and I just wanted to post my story so that it may help someone else.

I started my lapband process in March of 2011 my BMI was 38 with comorbities.

When I started this process I had Hypertension being treated with medication. Gerd-on medication,High Cholesteral.

My insurance denied Lapband surgery due to not meeting there qualifications under there policy.

First Denial came in and at that point I talked with my office insurance gal instructed me that you can

appeal but you can't appeal with the same information as first submission and also said I can have Lindstrom

Healthcare Advocay look at my file and see if they can help with getting it approved. I did that and from then on Kelley

from Lindstroms handled my appeals before we sent in our second request I had a sleep study done and was diagnosed with Mild Sleep Apnea also and a upper GI that confirmed GERD and Hiatal Hernia- submitted appeal. My Insurance company still

denied the 2nd appeal in NOv. 2011. Lindstroms then submitted a external appeal and finally at this level I just got notification

yesterday Feb. 2012 that the decision was overturned and it was determined this surgery is medically necessary therefore my insurance will have to cover it.. I will be scheduling my surgery soon so my message is to be persistant, don't give up if you get denied talk to your healthcare office insurance about the Lindstrom Group- this is FREE of charge to you if they take your case. I believe it is paid through Allergen which is the Maker of the lapband. If it wouldn't have been for Kelley at Lindstrom's I would not be scheduling my surgery.

[readytogoforit 172]

good for you! persistence works!