Get mad, fight back, win your appeal, and get a lawyer

So many people are emailing from my old post and reading these posts breaks my heart. Get mad, get angry and then get even. I tried a lawyer, a so called avocate, ugh, 6 months of non returned calls, and then I went through a private patient advocate. Another mistake. And my own. I researched my surgeon and thought lawyers and advocates whatever, I was too trusting. My lawyer did nothing, my advocate did nothing but bad mouth lawyers, miss a deadline and get me no where. And, let me tell you. At the very least, lawyers are insured. These advocates who troll for our business have NO insurance. If there is a mistake done. And our chance for surgery is lost. What recourse did I have ...NONE. These companies make me so mad I can scream. I gave in to someone's advice and hired a lawyer on www.obesitylawyers.com. I got Gary Viscio, and yes I was impatient, and he did tell me to wait, but he got it passed, when no one and I mean no one else was able to. These companies respond to one thing, firepower. A lawyer can take the next step. An advocate cannot. A lawyer has a license, experience and insurance. An advocate does not. My advice. IF your advocate is free of charge give it a shot. If not. get a lawyer and check them out. Like you would your surgeon. You want to know how we did it. We threatened them with a lawsuit. Why? Because Gary uses all tactics he can. In my case he found overchaging on a recent procedure I had and filed an insurance fraud complaint. Boy did that get them scared. My friend in Florida called an advocate and some specialist lawyer. They both said gee if they cover the RNY just get the RNY. She wanted the DS. So. Gary go her the DS, out of network and out of state. Fight back people. Don't lay down. Don't give up. M

I DITTO this!! Gary is the best and he really cares about everyone of us out here on this board. I would not be surprised to see Gary get it over turned in Court that EVERYONE can have WLS if it's necessary. Donna

I wish someone would do something about these insurance companies. After going through Cigna's, 6months of WI and being approved 12/14/04, I found out that there is an exclusion cause now. It seems like they should have to 'grandfather clause' the people that started there process in 2004. This is horrible.

I agree with you on this matter. It's like with me. It was only 6 months of dieting and then suddenly in 2004 they changed it to 12 months but when I started this WLS journey I was under the 6 months only diet so I should have still been under the 6 months clause. It's not fair how they treat people and your right on that we should fall under Grandfather rights. Donna

I'm glad that you were approved, but I disagree with your attack on Patient Advocates. If an attorney loses an appeal, you have no more recourse than if a Patient Advocate loses an appeal. I don't know who you used prior to G.V., and I'm sorry it wasn't a good experience. Gary will be the first one to admit he hasn't won every appeal. No one is perfect, no one wins every time, but we all do the best work we can. Personally, I don't take an appeal if I'm not reasonably sure I can win it. There are good and bad attorney's, advocates, and people in general. To make generalizations on an entire class is usually unwise, and unfair. Fight the good fight! Roberta

I'm sorry but I agree with Meghan. I had the same thing happen with me. A patient advocate represented me during my first request for authorization - DENIED - then my surgeon's office recommended getting some power and authority behind my request and show the insurance company that I meant business. I hired Gary and the rest is history. I had surgery almost three weeks ago and I still can't thank him enough. Gary was up front with me and told me that there was a chance that it would have to go through numerous levels of appeal. He never made false promises, but he did promise that all legal avenues would be explored through Aetna and even after my doctor's office said that only 10-15% of Aetna patients get approval, he got me approved. In 2005, Aetna wrote off all bariatric benefits, so Gary was working against the clock and though he handles many cases at any one time, he put the extra effort into mine, given the cir****tances. Nothing against Roberta, because she was not the advocate I used, but Gary was the one who came through for me when others could not. I would recommend him in a heartbeat.

I'm in the middle of an appeal, G.V. is representing me too, I'm glad to see that he has won so many ccases for people on here. I am praying that mine is won also. My denial was sent to me 3 weeks after my approval, get that is that legal or what? I was all mentally prepaed and then to get that kick in the a$$ was and is a real bummer. It seems that the insurance co. found an exclusion that husbands HR dept. convenietly threw in at the last minute{ I think they found out I was aout to have the surgery} Well I hoope Gary will win mine too.