2 Revision Denials - Hired Lindstrom Obesity Advocacy

[Taunter 15]

Hello!

I had lap-band installed in April 2009. Lost about 50 lbs total and have since gained back about 30. So net loss = 20 lbs. That's okay, though, because that weight was the difference between being mobile or not (weight at time of surgery was 382 - I'm now in the 358-363 range). The advice I got after the band was not to eat rice, bread or Pasta for 6 months after surgery and to go in for periodic fills of the band. I had 3 fills before losing my job, my insurance, and eventually my home to foreclosure.

Fast forward to October 2015. I'm diagnosed with Type 2 diabetes. I immediately look into getting a revision. While I start seeing a nutritionist and taking all the vitamins/supplements and learning to eat Protein first and 3 meals a day, I'm consequently diagnosed with Severe Obstructive sleep Apnea. Approximately 6 months later, I'm diagnosed with GERD. The local surgeon in my small town was requiring that I lose 40+ lbs before he'd qualify me for surgery and was pushing the Sleeve on me (even though I knew By-Pass was the best route).

After struggling to lose (I gained about 9 lbs in the 6 months under that nutritionist), I chose a different surgeon. This one the head of his department and very experienced bypass surgeon. Started seeing a new nutritionist (May 2016) and slowing started losing weight - about 1 pound a month. He only required I lose 15 lbs which was a MUCH more achievable goal in my eyes. I finally qualified in October 2016.

Blue Cross Blue Shield declined my request for coverage on 11/30/2016. My surgeon did a peer-to-peer review on 2/1/2017 and I was declined after that as well. After hearing from someone in a Facebook revision support group, I decided to look into Lindstrom Obesity Advocacy. I spoke with Kelley Brown Lindstrom earlier today and just sent over my records and payment. I'm paying for the expedited service (they get my file together and submit it within 3 days). So far my impression has been very favorable. Kelley has been knowledgeable and supportive and I'm impressed with her breadth of experience with different insurance companies. For the first time in a very long time I'm hopeful that I could have this revision sometime this year!

Anyway, I'll keep people posted as to how it is working with them. Wish me luck!

[airapril 1]

Any luck using them?

Sent from my SM-G930V using BariatricPal mobile app

[painter88 101]

You did the right thing..

I was very happy with Kelley, and you got it...... I was approved after 2 denials.

Am 4 months post op and I lost over 75 Lbs.

Sent from my SM-G935T using BariatricPal mobile app

[Bugaboo77 18]

Ok. So, I had received prior approval from my insurance to get my band removed.
That was done Feb 8 as there was medical necessity. My insurance is now denying payment for the surgery I had because they didn't receive a referral from my 'primary care clinic'. I had been dealing with my bariatric doctor and my surgeon regarding the issue...why go back to my primary care clinic?
I sent in for appeal and it is denied again.
I can't afford to pay $18,000 that it cost to remove my band.

[SIPS in Seattle 345]

Back in 2010-2011 I was denied twice for my band. Lindstrom helped with my appeals and I was finally approved. Just got my approval for revision without assistance which was shocking to me but I'm forever grateful for Lindstrom for their help back then.

[Taunter 15]

It 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 Lindstrom at Lindstrom Obesity Advocacy. If you find yourself stuck with denials from insurance companies, I highly recommend them!

[Brttnyj89 30]

On 9/5/2017 at 12:50 PM, Taunter said:

It 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 Lindstrom at Lindstrom Obesity Advocacy. If you find yourself stuck with denials from insurance companies, I highly recommend them!

Is there anyway I could private message you about this!

[Taunter 15]

Of course!