Need a lawyer referral

Anyone in iowa, preferably central iowa but not limited to, know of a lawyer that has dealt with wls and insurers? PLEASE send their names & locations asap. Mt tpa is constantly changing the wording to block my approval.

Oh, Jocelyn, I didn't know you were having such problems. What is tpa? Is the hospital still being butts about this? Let me know.

Jocelyn, I am so sorry that you are having problems. I am afraid I don't know any Insurance Legal Eagles in Iowa. I wish I did! Have you tried contacting the Insurance Commisioner? Another route is to petition your employer to take new bids to change insurance carriers. This can mean your portion of the premium may change, but it could be worth it. If insurance companies would just realize that they will actually save money in the long run! The long term drugs and medical care we require when we are obese far exceeds the short term cost of the surgery. There are some carriers that are more concerned abou****ching today's bottom line than the health of their participants. The drugs I am on right now just to get through the day and be functional cost in excess of $3000 a year. I am only 38. You look at the life span of a person and that really adds up! My final suggestion is to get the Insurance company to give you the qualifying criteria in writing,(if you haven't already) and submit rheams of documentation as to weight loss attempts and medical problems and medications required and the cost of care as you are now. Also get several (3 or more) supporting medical opinions as to the benefit of the surgery for you. I have been told I will be off all but 1 medication eventually. That sure beats the 7 a day I have to take now! God Bless and God Luck. Rachelle

Jocelyn, You need to be talking with your employer! Since you are dealing with a TPA (Third Party Administrator) that means that your employer is self funding you plan and they are the ones that are changing the wording, not the administrator. (I have worked for various TPA's in Iowa for 16 years now) I would suggest that you go directly to the head of your human resources department and ask they why they keep changing the plan and let them know that you will be contacting a lawyer. As for the lawyer, contact the Iowa Bar Association and they can give you a referral. The other option would be to contact a lawyer locally and ask them for a referral, either way, you should be able to be directed fairly quickly. I t might make you feel better to contact the insurance commissionar, but since your plan is self funded, you TPA would just direct them to you employer, so I think you are better off just to go to your HR directly. Please feel free to contact me directly if I can be of any more help (when I was working in the office, I delt with alot of the appeal letters that we recieved, so I might be able to give you some tips in dealing with your TPA). Kris

Thanks everyone, keep those suggestions coming. And Kris, Yes, I have been talking and talking to my HRdept. They know every detail and they don't care. WHat they told me was they willlisten to the TPA. What ever the tpa says is what they will decide. This gets them off the hook and clears their conscience I guess. Like Pontius Pilate. And this is a hospital (Pella Regional Health Center) in a very religious town that has a We Care motto and the mission statement is all about having Christian compassion. I'm wondering if it would do any good to go to the CEO and rat them out. I have one ace in the hole. We had a different tpa last year. There were 2 employees who had the surgery and they were denied after having it. They did not meet the criteria, yet somehow they got PRHC to pay for it. If I can show that they have already set a presedent by allowing surgery even if the patients did not fully meet the criteria I might have a little leverage.

Hey Jocelyn, I'm sorry you are caught in kind of a catch 22 here, but here is what I can tell you about the relationship between an employer group (Pella Hospital) and their TPA. The employer has the final say in what is included in the plan and what is not. That being said, I would ask your HR dept for copies of all of the plan revisions so that you have the most current information. If they can not provide you with documentation that WLS is specifically excluded, no exceptions, then you still have a chance in getting this approved. If it is not excluded from your plan, then I would go to the TPA and ask them from written documention of their critiria for approving WLS. This way you know exactly what you have to do to get the approval. Keep me posted! Kris

Hi Jocelyn - my fiance was having problems with a former doc and we thought about medical malpratice - it was for a totaly different medical problem but the agencies with legal help that were suggested were the following: Iowa Legal Aide (515) 243-1193 and Iowa Concern ( a division of Iowa State University Extension Services) at 1-800-447-1985. I know Iowa Concern for legal help is only available during business hours on weekdays. Hope this gives you help and hope! Take care and my thoughts and prayers are with you. - Carol