Question:
HMO DENIED ME!!! CONTACTING WALTER LINDSTROM

I just received my denial letter from my insurance. I have Health Net HMO in calif. I was approved to see the surgeon and then they denied me for the surgery.They said the medical documentation received does not suport the need for this service because you do not meet health plan criteria for gastric bypass surgery. Boy o boy was I hot when I read this!!! They say I can appeal this and you can bet the farm I will. My bmi is 45 with no co-morbidities!!! I admitt I am healthy as a horse but I have lower joint pain constantly,shortness of breath, and constant burning in my chest after eating or drinking alot of fluids. I have e-mail Mr. Walter Lindstrom for his help with my appeal letter. I want him to write it. Has anyone used him and I would like to know the outcome with his help. I very depressed and if anyone can help me or give me any advice or words of wisdom. I want to hear from everbody who has had to appeal this. My humble thanks to all !!!!!!!    — Laura G. (posted on May 20, 2001)

May 20, 2001
Laura, I am so sorry that you are having problems with your insurance company. I have a HMO also (Health Alliance Plan in MI). I had to use Walter Lindstrom also and I must say it was money well spent. There was an absolute exclusion for WLS but it was medically necessary for me to have surgery. It took a year before my insurance carrier approved me to have this surgery. Although I had Mr. Lindstrom representing me, we had to exhaust every appeals and grievance process. Mr. Lindstrom is thorough and he is tough. I think that you will be pleased if you utilize his services. Mr. Lindstrom got me approved and the insurance company still tried to hold me back, but Mr. Lindstrom stayed on them. I am happy to say that I had my surgery on 4-26 with absolutely no out of pocket expenses. I hope and pray that your fight will not be as long as mines was. A plus for you is that you were allowed to see a doctor, I was not. God Bless you with your fight. If you have any further questions, please feel free to e-mail me [email protected].
   — Margaret M.

May 20, 2001
I tried to email you but AoL said you were not a known member...I have health net and did not even get a consult with a surgeon. Although I had a support letter from my PCP and a vascular Surgeon. I met all criteria except I did not have a "dr supervised diet" that showed I could not loose weight with in the last 5 years. HUMMM. so I found all my information and charts for the 17 months of phenfen and sent it to the insurance. I am in the middle of the appeal/grievences part with the Insurance, that is a 30 day process. I Also went that way first with the case manager at my medical group , this was the first 30 days.... So my appeal stage is about up, I am preparing my self just in case the answer is no agian. I have contacted Walter Lindstrom, and received all his information. HE charges $350 to $750 depending on what you want him to do. He does NOT guarentee anything. But he will tell you if he feels you are a good canadaite for him to help, so write to him, via email and tell him your story, and they will tell you if you qualify, they will then send you a packet in the mail. I received papers with my name already on them, saying I want this or that, and I just have to fill in the blanks and get him several items to have for my file. Like the ins booklet for coverage, my appeal letter, my med files, stuff like that. You will need to do the digging for him so he has what he needs to start on your appeal for you. I am hoping this has helped you some. I hope you and I can win this battle.
   — Debbie H.