Question:
If the company has a policy that has an exclusion, will hiring an atty
do anything other than cost me money? the exclusion reads as follows---surgical and non-surgical treatment of obesity(including morbid obesity) I am trying to have a revision done and of course it was denied. I got my package from Walter Lindstrom, and am ready to send off 1,100 for an expedited appeal..will it be worth it, if its a company exclusion? — tylerswife (posted on February 13, 2005)
February 13, 2005
Why are you having a revision? If it is strictly because your first
surgery failed, I would think it would be wasting money. However, if you
are having complications due to your original surgery and 'fixing' the
original surgery would cure your problems, they go for it.<br>I had
the UHC exclusion and had my RNY repaired because of 'other' issues.
— RebeccaP
February 13, 2005
— [Deactivated Member]
February 13, 2005
Rebecca, my insurance policy also has a written exclusion but on the policy
by UHC. Unfortunately, there is nothing I can do to overturn the
exclusion. What I was told by our insurance broker is that insurance
companies do not have to allow the surgery to a company if there are less
than 50 employess, as is my case. My HR Director even tried to have it
overturned and the answer from UHC was NO!!!! I think it is
discriminating, however, I really don't feel like fighting it. I will be a
self-pay with Dr. Wongsa, my thoughts is "it's only my life savings,
but I am young enough to save for the future". If your employer but
the exclusion in the policy, someone in your company can make an exception
to allow you the surgery. Best of Luck! Dana
— cajungirl
February 13, 2005
I hired the Lindstroms and my exlusion clause was overturned. Now it was
for the surgery itself and not a revision, but they are good and I work for
a Fourtune 500 company. You can read my profile for more information, good
luck. Sometimes you have to just try ...Email me if you need more info.
— jenniferw
February 14, 2005
Hi Rebecca. I would send the 1,100 bucks to the doc and make payments. Lots
of docs will let you do that. Some even have low interest financing thru a
third party. I personally would not waste my time with an attorney. It'll
cost money and you probably won't get the satisfaction. If you put the 1100
towards your surgery you are on the way to getting it paid.
In reference to the one who asked why you are having a revision. Well I
just had one. In Sept. It is the best move I have made. They didn't do RNY
when I had my VBG in 1981. But I did well initially and never got back to
320, but I can tell you, I have struggled for the past 10 yrs and done the
diet yo yo thing even with the VBG still working. So now it is revised and
I feel like I finally have a great shot at getting it off and keeping it
off. Go for it!! Don't give up. With the malabsorptive part of the RNY the
weight loss avenue is much better. God Bless and Good luck. Hugs. Jo
— Jo Marie M.
February 14, 2005
Umm, I think my answer may have been misuderstood. I asked why she was
having a revision because insurance companies will look differently on a
revision if it is to repair something that is causing problems as opposed
to a revision stricltly because of weight regain. I wasn't asking why
someone would have a revision...as I stated in my intial post, I have had
one as well. :)
— RebeccaP
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