Approved after external appeal!

[izzy13 117]

I haven't posted too much on here especially since I was down in the dumps bc I was denied by my insurance and thought surgery would never be reality for me.

Through posts on here though, I heard of lindstrom advocacy group so I contacted them and they recommended I do an external appeal of the denial with my state (NY).

I just heard from Kelley Lindstrom about an hour ago that my external appeal overturned my insurance denial and they HAVE to cover my surgery!

I'm so excited, anxious and just happy to have surgery as an option in my weight loss journey. I cannot recommend Lindstrom enough for anyone going through a denial, my insurance had ridiculous requirements, ones that if I had the ailments they required no surgeon would touch me and I was so defeated but Kelley gave me hope and its now a reality!

First phone call tomorrow morning: doctors office to get my surgery on the books :) :)

[KristenLe 5,979]

Woohoo - that's awesome! Congrats!

Sent from my KFFOWI using the BariatricPal App

[rebelchelz 52]

Congrats!! That's Awesome!! Good Luck on your journey!!

[dede0314 356]

Congrats!! I know the feeling I also was approved through external review and hired Lindstrom. Kelley is amazing. Good luck with your journey!!

[izzy13 117]

I called my dr's office, 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.

Scheduler said she's penciling me in for a tentative October date....fingers crossed

[dede0314 356]

What Insurance do you have

[izzy13 117]

It's called capital district physicians health plan or cdphp, it's big but specific to the Albany,ny area - it's not attached to any of the big insurers like UHC or BCBS etc.

[Witchyeyes1014 1]

does the Lindstrom group work with someone in Florida or are they just for NY. My Insurance just denied me and am so devastated. I spent money i did not have getting behind on bills just to get the tests and doctor visits needed to submit it to the insurance. United Healthcare did not cover most of these. i need all the help i can get to appeal this. I was denied because I did not have a BMI of over 40 for the past 5 years. I have had over 35 most three of the 5 but i have had Hypertension, sleep apnea, and now diabetes. plus gout and PCOS.

[dede0314 356]

They work with people in different states your location doesn't matter I'm in Illinois

[KristenLe 5,979]

@@Witchyeyes1014 Has your surgeon attempted to do a peer-to-peer review to get it overturned? This doesn't sound right at all and I would definitely not accept this. You shouldn't even NEED a BMI over 40 with those co-morbidities! This makes no sense and I would fight them on this - do you have your plan benefits that indicate when it's covered?

[Witchyeyes1014 1]

does the Lindstrom group work with someone in Florida or are they just for NY. My Insurance just denied me and am so devastated. I spent money i did not have getting behind on bills just to get the tests and doctor visits needed to submit it to the insurance. United Healthcare did not cover most of these. i need all the help i can get to appeal this. I was denied because I did not have a BMI of over 40 for the past 5 years. I have had over 35 most three of the 5 but i have had Hypertension, sleep apnea, and now diabetes. plus gout and PCOS.

@@Witchyeyes1014 Has your surgeon attempted to do a peer-to-peer review to get it overturned? This doesn't sound right at all and I would definitely not accept this. You shouldn't even NEED a BMI over 40 with those co-morbidities! This makes no sense and I would fight them on this - do you have your plan benefits that indicate when it's covered?

I called Insurance and they advised to have my surgeon do the Peer to Peer and see what happens since I do have those Morbidities that should qualify me. in the mean time i guess i need sit tight and if that doesn't work i have to appeal. Thank you.

[Witchyeyes1014 1]

My surgeon is supposed to call on Monday and do a Peer to Peer. I'm hoping that works.

[KristenLe 5,979]

It should! They're wrong in denying it in the 1st place.

[izzy13 117]

The lindstrom group works in all states I think, they are actually based out of California. If the peer to peer doesn't work (I didn't have one of those done, my insurance required me to appeal on my own and NY has this thing called an external appeal where you appeal to the state and the state makes the decision based on common practice not the insurance), you should definitely look into either lindstrom or at least look online for sample appeal letters that may boost your case against the insurance. It took 4 months (my stuff was submitted in April and denied) but if you stick with it you should get it approved. Someone told me, the insurance always denies bc they want people to give up so they don't have to pay....so don't give up!!! [emoji4]