APPEAL SERVICES

Our office provides Services for any person who was denied coverage of a medically necessary procedure be it Bariatric Surgery or Reconstructive Plastic Surgery.

Unlike others who claim to have an "inside view" of the Bariatric Field based solely on relationships with large corporations, this office takes the additional step of knowing the inside of the Insurance Industry and keep our knowledge of Insurance Law up to date.  In other words, we win our appeals because we maintain the latest Medical Research and Legal Case Law and Statutes.

We have become highly respected by many insurers because of our ability to successfully navigate the insurance field.  In fact this office has represented individuals who are seeking the Surgery who are employed by the very carriers that have refused the Surgery.  In other words, you are not alone.  You have not been singled out by your Insurance Carrier.  We all have.

"EARLY INTERVENTION PLAN"

This program is for clients that are beginning the approval process. Whether you are thinking about having the surgery, have applied for authorization or are awaiting a decision, this program is aimed to help increase you chances of first time approval before ever being denied. This lets your insurance company know from the outset, that you will not simply run and hide if you were denied, and have already taken steps to protect your rights.

This Plan consists of submission of a customized correspondence to your insurance carrier which provides additional information not included in your Surgeons request for authorization. This plan outlines the medical reasoning for the Surgery, but also shows the legal theory under which your claim rests and explains why the Carrier is legally required to approve you.

The fee for this service is a flat fee of $225.00. If for any reason your request is denied and you wish to retain our services for the appeal, that fee is fully applied to the balance of the appeal.

After obtaining your medical documentation, and a personal history from you, we create a detailed comprehensive Appeal to your Insurance Carrier outlining the Legal and Medical reasoning behind our argument as to why your Surgery must be approved.

Our Appeals are very lengthy and include your fully documented medical history and your policy's requirements as well as the specific State and Federal Case Law that apply to your situation. In short, we provide the carrier with the proper documentation and reasoning upon which to approve your request for Surgery.

Our Appeals do not simply rely on a plea for help. It is important that we include with your medical history the rationale for the surgery and the sound legal reasoning behind our demand.

A single appeal with follow up contact with your insurance carrier is only $450.00. Our fee is well under that of any other firm. More importantly our record speaks for itself.