Dr. Shayani as obesity lawyer?

has anyone used Dr. Shayani who is a surgeon, but also an obesity attorney to help fight insurance denials? My sister in law has Unicare insurance with a casino here and was denied becasue her "obestiy was not caused by another disease". Now, since she only has one appeal, my doctor's office referred her to Dr. Shayani for appeal. We were trying to find any comments on Dr. Shayani or if anyone has had success with him, but I don't see any here. Any help would be appreciated.

Dr. Vafa Shayani?

I don't know what his first name is. We have called his office and his office staff was really helpful. His website is www.obesitylawyer.com but I haven't had a chance to go look at it. She just doesn't know what else to do at this point and with xmas right now, she can't afford the appeal costs either. Maybe after first of year. Doctor's office said that some patients have appealed this plan and won, but most have lost. Does'nt sound very promising. She's just very frustrated. I also have a plan (BCBS) that doesn't allow surgery. Mine excludes. Hers covers but has said it's not medically necesary. Does this surgery ever happen???

I only know of www.obesitylawyers.com, you should email all the lawyers and patient advocates or try a self appeal.

oh, and you should check out shayani's website, it only takes a minute.

Meghan, I looked at both of the websites. You said "all the lawyers"-are there more? And, patient advocate-what is that? Is that the same as teh pateint advocate through her insurance company?-because that was a dead end. The worst part is that the doctor she was going to use here in Louisiana (Dr. Chung) is booked until mid January. Her insurance is going to write off all coverage of the weight loss surgeries on January 1st. I tried calling around to other doctors in the state, but they wouldn't even take Unicare because of how hard it is to get this surgery approved.. The lady in his office, Marci, has been very helpful, but she says that Unicare is not allowing ANY patients to be approved right now. She said she has a stack of 12 or more denials. There is a class action suit I saw on the home page of this site that I will look into for her, but right now it looks bleak. Marci says that denials take usually 30 days or more for appeals to be done and by then, she will no longer have coverage. So, I don't know if it's worth it for her to pay the $495.00 for an appeal that won't go through in time. This is just a sad situation for her. Thanks for your suggestions, though. I actually had talked to Mr. Visceo about my insurance, but there was nothing that could be done. BCBS and Unicare just won't pay for this to save a life.

Bryan, You should file an appeal now, BEFORE the end of the year. On 1/1/05 when they do exclude it, you at least will have an appeal pending so that if you do win, they would have to honor the decision as you are appealing an improper denial when they did cover the surgery, albeit with nonsensical requirements. File an appeal, send it certified mail and list the NIH requirements for the surgery. At the same time you should file a complaint with the insurance commissioner in Louisiana. 1-800-259-5300 or go to this website, http://www.ldi.la.gov/consumers/complaint_info.htm and download the complaint form. One problem with your State is that they normally do not overturn denials. However, because this is not an exclusion, it is a medical necessity review they may entertain your complaint. As for the class action, I can tell you right now, it is not going to work. First, you'd have to show that you exhausted all of your appeals, and second, we looked into this already. I know the office involved in the suit, and I personally met with some of the top class action lawyers in the Country in August to review this. The problem is that we voluntarily purchase a policy that excludes or limits the surgery. There are no laws that say the surgery must be covered, in most states. Only six require coverage and those States have been pretty good covering the surgery. The one's how don't will not. It's like purchasing auto insurance. You purchase what you want and accept what they offer. That's it. So for right now, I would suggest you get a complaint on file before the end of the year and get this moving. Again, even if you win lets say in January they're going to say gee we don't cover this as of january 1st. Well that's too bad for them and you'll need to remind them that this was an appeal of a decision made in 2004 and that decision is wrong and as such you revert to the coverage when the policy was in effect. Good luck

Mr. Viscio, Dr. Chung's office did mention something about that, but when Mary (my sister in law) called her insurance, they said that was not true. They told her that no procedures would be paid for after if they were done after 2004. Marci from Dr. Chung's office was supposed to be checking into it. Mary is still waiting to hear back from Dr. Shayani's office and getting kind of discouraged. Unfortunatley, she doesn't have a computer and doesn't know how to work it anyway. Marci had actually referred me to your office earlier this year, but I have BCBS and they don't cover it. I asked about Mary going throuh your office, but apparently y'all don't work together anymore. I am going to give Mary your information from your website so that she can know her options. Thank you for your information. I hope you are right, for her sake.

The customer service rep probably did not understand the issue. If you were denied in 2004. and it turns out that the denial was improper and it is reversed. Then they have to pay. This is a constant game with all companies. But, you have the law on your side. BCBS Is very tough in your state. Louisiana like I said allows companies to exclude coverage. If it's BCBS of another state she has a better shot at it. Dr. Chung is one of the best, but I have limited my work to certain areas recently. However, if she is being made to wait this long, the clock is ticking. Email or have her email me directly and we can talk about getting this done for her. Gary

It's not BCBS. I have BCBS. Hers is Unicare. She spoke to Marci at Dr. Chung's office yesterday and she is actually working with the doctor/lawyer on all the denied cases with the same insurance. Thank you for your suggestions, though. It's appreciated.