Any first hand experience with Obesity Law or other attorneys?

I received a letter of denial last week. I had been told that my policy included coverage for WLS. The letter stated it did not--however, no one has ever used the term "Exclusion." The letter is from my primay insurance. I have not heard back from my secondary but they have a tough exclusion clause and have denied me in the past (surgeon sent the info anyway just in case). I have tried appeal letters in the past with different insurances with no success--I've been trying to get aproved for 2+ years. I decided to have an attorney review everything before I started another series of appeal letters. If anyone has experience with Obesity Law or other attorneys who have experience in this area I would appreciate hearing from you. Thanks so much.

Bob: I am not an attorney, but I do have years of experience working with health insurance companies, so I know the "hoops" that people have to go through sometimes. I am sorry that you received a denial letter. The first thing that you want to do though is to review your evidence of coverage. It is this multipage document that will lay out what is covered (and under what terms) and what is excluded. When you signed up for coverage, you should have received a copy of this for your records. Most states require that your health insurance company provide you with this document. Submitting to your secondary payor (insurance company) is going to be an uphill battle for two reasons: 1) Many secondary payors will not cover a procedure that the primary payor does not cover, and 2) weight-loss surgery is an excluded benefit. In my professional estimation, your best bet is to use your appeal option. When submitting your appeal, it is mandatory that you gather as much information about your procedure and how your health can be ultimately improved (and, thus, health care costs mitigated) by having the insurance company cover it. Ultimately, the appeal will have to present compelling documentation and information as justification, or you will continue to receive denials. Your provider should be able to assist you with all the medical information needed to try to persuade the insurance company. I used to work with nurses and doctors in reviewing appeals, and we looked for two things in determining whether to overturn a previous decision: 1) medical necessity (as opposed to medical desire), and 2) the mitigation of future health care costs by covering the requested procedure. For most insurance companies, if you can answer those questions in your appeal, you should be able to convince them to change their mind. Forty to fifty percent of appeals are overturned based on this line of reasoning. Please feel free to e-mail me if you have any further insurance questions. I pray that I was able to provide some type of assistance to you.

I have talked with Gary, the forum leader for this forum and owner of Obesity lawyers, I know he has helped many, and would have had him help me.  but I recieved help from my union legal staff, Congressional staff, employer  human resorce staff,  I even had the Naval Advocate General staff helping me with tricare.  and Aetna, and lost. for a DS,    Justice is not always Fair.   I think thats how it goes.  fortunately,  a new diabetic drug has come along and now i dont way enough to have wls. for now anyway.

I used Gary Viscio and he is not only reasonably priced but great! I only had one level of appeal in my plan and I wanted to make sure the appeal was a good one. I never could have put together any where near as persuasive an argument as he did. I was approved for lap band surgery within a month of hiring Gary and had my surgery 6 weeks after that. I highly recommend him.