Q. HOW CAN I OVERTURN MY INSURANCE COMPANY'S DENIAL?
A. Every policy of insurance contains provisions as to what treatments are covered and the course of action to take if coverage is denied. We follow those rules, and apply the medical and legal theory behind our argument to justify your approval for the surgery you have requested.
Q. IS THIS GOING TO BE EXPENSIVE?
Fear of professional fees are unfortunately one of the primary reasons why many Americans, in our opinion, are denied access to health care they require. Many people cannot afford costly fees and many attorneys and other types of advocates charge fees which are greater than the costs of the treatment being denied.
Our office has worked very hard to make high quality services affordable to anyone who needs them. We have kept our overhead extremely low and have streamlined our file handling to maximize results for our clients. We'll discuss our various fee options with you on an individual basis, but our current structure starts under $450, depending on what you require.
While it is important that this office charge and collect a fair fee for the work that we do, we have never allowed someone?s ability to pay fees to be the final deciding factor as to whether or not we can help them. We don?t want anyone to not contact us simply based on an erroneous assumption that hiring us is too expensive. We will work hard, if necessary, to create a payment plan which meets your personal situation.
While we have litigated these cases in court or in administrative hearings, the vast majority of the work we do is non-legal in nature. We analyze your matter, your insurance contract and medical records, prepare a comprehensive written appeal that addresses all the possible reasons to approve the surgery and, if you retain us for this purpose, we represent you (usually telephonically but sometimes in person) at grievance and appeal hearings and prepare you for those hearings. Given the fees we charge (which we are happy to address with you on an individual basis), it is a tremendous amount of work for a very, very reasonable rate.
Q. CAN YOU REPRESENT ME EVEN IF I DO NOT LIVE IN NEW YORK?
A. Yes. We are not required to be admitted to practice Law in your State unless we are forced to file a lawsuit. If that happens, we would become affiliated with Attorneys in your area and would be able to practice law in your State under those guidelines. The filing of a lawsuit is fortunately a rare occurrence as a result of our successful appeals, however, if required this office prides itself on our litigation ability.
Q. WHAT ABOUT EXCLUSIONS?
A. Exclusions must be written in a very precise and particular way to fully exclude the surgery. Beyond that, many States under Law require coverage of the Surgery if it is medically necessary. Again, it is because of our use of Legal theory coupled with the medical basis for the surgery behind your claim that has allowed us to overcome exclusions. Please keep in mind that not every situation is alike and exclusions are more difficult to overcome. Our office has the legal skill and knowledge required to confront the Insurance Company with overwhelming medical and legal arguments in order to overcome exclusions. We carefully evaluate all such cases, but if our experience has not been positive, we'll tell you that straight out and suggest that you not retain our office. If, however, we have never dealt with your plan or the contract language at issue, we may offer our services to you. You should understand that exclusions are the toughest cases to overturn, although we certainly have had our share of successes in many different situations
Q. WHAT ABOUT DIET HISTORY?
A. Carriers that require a diet history vary from requiring simple proof that he surgery is your last resort, to requiring 6 months of documented diet history to as long as 12 months. We do not "get around" this requirement, but rather using your medical records, the applicable case law, State Law and the carriers own policy language we are able to demonstrate that you have, like most, tried every diet at one time or another.
Q. DO YOU HANDLE RECONSTRUCTIVE PLASTIC SURGERY CLAIMS?
A. Yes. But... we review your claim to ensure that it is a true reconstructive plastic surgery request. Most carriers consider this type of surgery Cosmetic Surgery. However, each plan has a definition of Cosmetic and Reconstructive. It is important that the reason you are seeking the Surgery is because you are unable to treat your condition without surgical intervention, and your medical records prove that. Upon reviewing your case we can advise you of your chances of success.
Q. WHAT IS A SELF FUNDED PLAN.
A. ERISA is a Federal Statute that pre-empts State Law in situations where your insurance policy is self-funded by your employer. In that situation, your employer has hired an insurance company only to administer the benefits. Federal Law allows the employer broad discretion in drafting the policy. "Iron Clad" exclusions are possible. Again, each policy as written is different and must be reviewed thoroughly under the Law to enable us to provide you with recourse against your carrier.
Q. WHAT ARE YOUR FEES?
A. If you are in the early stages of the approval process and have not been denied, or even filed a request for the surgery you should review the section entitled "Our Services". In that situation our fee for our "Early Intervention Plan" is only $225.00. Our fees for an appeal of a denial based upon any ground is $450.00. Again, that is a flat fee. Varying fee structures are also available for different situations. It is our desire that no one is unable to use our services because of our fees. We work with everyone to ensure equal access to our services.
Q. WHEN SHOULD I RETAIN YOU?
A. It is important that you contact us as soon as possible. Your chance of success is greatly increased when we are enabled to enter the process as soon as possible.
Q. CAN I JUST PAY CASH OR GO OUT OF THE COUNTRY AND THEN SUE?
A. Ah, if it were so easy. Sure you can pay cash, if you have it, for your surgery. You can also go out of the Country. It's all up to you. But keep in mind that your complications, if any, and aftercare will not be covered by insurance. Also, if you do sue and win you will only be reimbursed at the contracted rate and not the money you actually laid out of your pocket.
Q. YOU SAID YOU CAN"T HELP, IS IT OVER?
A. NO way. We're just telling you that in our experience it would be a waste of your money and time for us to tell you we could help you when we know we could not. But that doesn't mean you should not appeal or work with your employer to change the rules. You should.
Q. HOW LONG DOES THE APPEAL PROCESS TAKE.
A. The typical time frame in which an appeal is filed an a decision received is normally within 4-6 weeks. However, these claims have gone as far as 120 days out. The carrier will try to delay your claim as much as possible. That is why it is important that you provide us with a detailed medical history and all of your documentations as soon as possible so that we can file your appeal and begin working with the Carrier to obtain an approval. It is also important that you, along with this office, follow up on your appeal with your insurance company. Many times we hear claims of lost or misdirected appeals. While we follow up on these appeals for a decision and to ensure receipt. We also encourage you to take an active role in the process. As they say, "the squeaky wheel gets the grease".
Q. WHO WILL I SPEAK TO FOR A CONSULTATION AND IS IT FREE?
A. As most people can tell you, when you call our office you will speak to Mr Viscio himself. Not a service, assistant or consultant. Mr. Viscio personally answers every telephone and email inquiry. Our consultation is always free. In addition we have been more then happy to provide our guidance to others even when they have chosen to go the appeal route alone.
Q. WHY ARE YOU SO Successful?
A. We like to think outside the box. As litigator's we have been steeled to ensure that an appeal is fully prepared prior to being filed. This enables us to ensure that the Insurance company is not afforded a "backdoor" or "loophole" to escape coverage. That is why our appeals are detailed and contain sound Legal and Medical arguments. We fully understand the gravity of the life and death struggle you are in.
Q. HOW DO I HIRE YOU?
A. Please call us or email us with your questions. All calls and emails are returned promptly. In fact, you will soon learn that client satisfaction is our priority. Mr. Viscio routinely gives out his personal cellular telephone number to ensure that your questions are answered as soon as they are asked.
Q. WHY DO YOU HANDLE THESE CASES?
A. We believe that no person should be turned away from this life saving procedure. The National Institute of Health has already stated that this surgery reverses all co-morbidities and can greatly extend your life. Gary Viscio, one of the firm's founding partners was afforded this life saving surgery. Why should anyone be denied this gift?