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FREQUENTLY ASKED QUESTIONS
1) WHAT
CAN THE OBESITY LAW CENTER DO FOR ME IF
I HAVE BEEN DENIED SURGERY BENEFITS BY MY
INSURER ON THE BASIS OF A LACK OF MEDICAL
NECESSITY?
If you have been denied insurance benefits
for weight loss surgery by your insurance
company on the basis that the surgery is
not medically necessary, the Obesity Law
Center can appeal your insurance company’s
denial of benefits. We at the Obesity
Law Center believe that the denial of benefits
on this basis is usually groundless and
will work hard to obtain those benefits
that you are entitled to under your insurance
policy.
2) WHAT
IF I DON’T LIVE IN MARYLAND, CAN THE OBESITY
LAW CENTER STILL HELP ME?
Absolutely. It is our mission to
get insurance approval for your bariatric
surgery. This is accomplished through
your insurance company’s appeal and grievance
process, which is generally an administrative
procedure and does not require us to be
admitted to practice law in each state.
If in the extremely rare case where we
would be required to file a lawsuit to secure
your benefits, the Obesity Law Center will
retain qualified local counsel to assist
us in your representation.
3) HOW
SOON WILL I RECEIVE A DECISION ON MY APPEAL?
Insurance Companies typically take 4
– 6 weeks to make a decision on your appeal.
However, each insurance company’s
procedures may vary slightly and the time
may be shorter or longer depending upon
the circumstances of each individual’s appeal.
Obviously, you may contact us anytime
with questions or concerns you may have
regarding your appeal.
4) I
HAVE BEEN DENIED SURGERY BASED ON AN “EXCLUSION”
IN MY HEALTH INSURANCE PLAN. CAN YOU HELP
ME?
Insurance coverage policies can be complex
and confusing. Many times health insurance
will exclude procedures or surgeries that
the company deems “experimental” or “controversial.”
These “exclusions” are based on the argument
that if the insurance company allowed these
experimental procedures, they would not
be able to pay for legitimate medical care.
Some medical procedures that are now relatively
common place, such as organ transplants,
were once excluded by insurance companies.
Alternatively, some insurance policies
specifically exclude any treatments that
relate to weight loss. This includes not
only bariatric surgery, but weigh loss and
exercise programs as well as any pharmaceutical
treatments. Most times this is done as a
cost cutting measure for those purchasing
the insurance.
Whatever exclusion argument given for
bariatric surgery not being covered should
not be an automatic barrier for making a
better you!!! The Obesity Law Center is
committed to helping you achieve your goal
of weight loss and a healthier life. Part
of our service will be a review of your
insurance policy so that we can determine
what your likelihood of success will be.
We will not make false promises. However,
we strive to provide the best service to
all of our clients and you can rest assured
that we will FIGHT FOR YOU!!!
5) LAWYERS
ARE EXPENSIVE. CAN I AFFORD YOUR FEE?
The Obesity Law Center prides itself
on providing quality legal representation
at a fair price. Most of our cases can be
handled for a fee of $300-$600 depending
on the complexity of the issue. Our services
can include your initial appeal, any subsequent
responses from the appeals, and any administrative
responses. We are ready and willing to work
with you to reach your health care goals.
We accept major credit cards and if necessary
can set up a limited payment plan. Do
not let our fee stand in the way of your
progress. Let us help you fight for
what is your right to be healthy.
6) WHEN
SHOULD I THINK ABOUT HIRING YOU?
The sooner you contact us, the better.
We have a number of ways we can assist you,
but the more involved we are from the beginning
of the process, the better off you will
be. The problem with waiting is that with
each step in the process, you lose some
of your options. If you wait too long after
an initial denial, you may not be able to
appeal. Likewise, if you wait too long after
the denial of an appeal, you may not be
able to take advantage of any legal or administrative
options that are available. Our goal is
to get your surgery covered, and the sooner
we start working together towards that goal,
the better the chances of success are.
7) HOW
QUICKLY WILL YOU PROCESS MY CASE?
The Obesity Law Center realizes that
this is an exciting and stressful time in
your life. Our staff strives to make sure
that your case is handled in the most efficient
and productive manner possible. When you
contact us, a member of our staff will make
arrangements to obtain all of your pertinent
information to evaluate your case. Mr. Hershon
or Mr. Allen will then contact you personally
to discuss your situation, look at any documents
you might have, and consider if you would
be best served by working with us. At that
point we will begin the process of building
your claims file. Once we have the required
information, we will be forwarding your
case to the all of the interested parties.
We know how important this issue is to you
and we will always make sure you are informed
and involved every step of the way.
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