How many hired a lawyer to fight insurance company - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Daniel Boone · 07-27-2008, 07:57 AM

Is it worth it and would it get there attention?

I know the company has covered the surgery for others.
DB

eli_far77 · 07-27-2008, 01:13 PM

I know of someone who did and she definitely got their attention and ultimately her surgery. She was very persistent.

jillagin2000 · 07-27-2008, 05:39 PM

I have. I'll let you all know how it goes LOL.

SueRN · 07-28-2008, 11:54 AM

It all depends on the reason it was denied. If your employer excludes the coverage...that has nothing to do with the insurance company. The fight would actually be with the employer in that situation and not the insurance company. If you don't meet criteria and it was denied for that reason, and you have exhausted all the appeals process, there is always a chance to fight it with a lawyer and get it overturned. Especially if you were close to meeting but not quite. Since I work for an insurance company, we get threatened all the time to be sued so it doesn't really get our attention. If you have really good documentation, and support from the surgeons and your PCP, there are also some obesity advocacy agencies that will help as well, go for it. But if it's an exclusion, you need to fight with your employer about it. If they overturn their decision or make an exception, the insurance company would approve it. Good luck. Sue

SlimmerDreams · 07-28-2008, 01:29 PM

I tried going through my primary Dr. and the insurance co. denied it. I appealed four times. I finally got the primary Dr. to refer me to a specialist (Dr. Callary) and it was then approved. Have you tried going around the Dr. that is submitting to the insurance co?

Blueyz · 07-28-2008, 05:16 PM

I believe Stuart hired a lawyer and received his surgery. I haven't seen Stuart or his wife Christina in soooo long. He may have some information posted here somewhere that might be helpful to you.

Daniel Boone · 08-04-2008, 08:15 PM

All though the insurance has it written they dont do care for gastric. Found out from several if your doctor pushs the issue they will cover it. Sometimes its finding the right folks to give the info you need. Unfair they deny some and not accept everyone.
DB