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Linx Procedure/ Insurance company approvals

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GERD & Acid Reflux
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Posted 8/11/2013 3:23 PM (GMT 0)
For the record, I have now had my appeal denied by Horizon and will have to move on to arbitration, or whatever they call the outside review.

I'm not a happy camper at all. I have a sore throat and will have to go Nissen if this doesn't work out. My luck, six months after Nissen it will be approved.
Posted 8/11/2013 7:23 PM (GMT 0)
Robotaz. Did they deny the entire thing or just the Linx device itself. Some insurance companies will pay for the procedure implantation itself but not the device which was $5,000. (Who knows--maybe if this is so then negotiations may be available for the $5,000. I remember reading this somewhere else on the forum. Wish you well.
Posted 8/11/2013 7:28 PM (GMT 0)
Robotaz. Here's ins info link

https://www.healingwell.com/community/default.aspx?f=45&m=2576939
Posted 8/12/2013 8:19 PM (GMT 0)
Pat, that's the same thread we're in now.

Anyway, no I have not discussed whether the procedure or device is what was denied. I will have to check. Thanks for the advice. I do know that "the standard of care" would be paid for, but not sure about the rest if LINX is used.
Posted 8/13/2013 6:38 PM (GMT 0)
Robotaz I would look into contacting Lindstrom Health Advocacy, they will help you with your appeal and it will cost you nothing for their service. There are 3 stages to the appeal with your insurance. The first two stages are internal reviews and the third is an outside party review. Once you give Lindstrom your information they take it from there. It is so much easier than doing the appeal yourself and they are more likely to get your approval then doing it on your own.
Posted 8/13/2013 6:40 PM (GMT 0)
Your best bet is to have the surgery center where you were going to have the surgery contact Lindstrom Health Advocacy for you.
Posted 4/6/2014 11:49 PM (GMT 0)
Blue Shield of Ca slimeballs denied the LINX procedure for me even though my 24 acid pH test was double the standard limit! I could not even eat or drink during the test so, I thought it would not show any acid! My results would probably be 4 times the limit if i could have eaten!!! I found that Lindsrom Advocacy in Southern Ca fights them for us, for free since they are subsidized. They are part of the USC Medical Group. Blue Sheild of CA really suck!!!!!!! Email me if you need information. Ron
[email protected]
Posted 4/7/2014 2:32 AM (GMT 0)
Ron. We understand the frustration. This article was recently sent to me explaining the various procedures, insurance companies and the comparison with a fundoplication. Also mentions the level of risk with the Linx. Seems that this is what Blue uses too. No wonder businesses go out of business and doctors are hesitant too.

http://m.generalsurgerynews.com/Article.aspx?d=In+the+News&d_id=69&i=March+2014&i_id=1046&a_id=26127
Posted 5/5/2014 11:10 PM (GMT 0)
Hi All~

I've been checking this board out from time to time, while waiting for my LINX surgery to make it's way through the appeal process. Even with Lindstrom Advocacy helping, Blue Cross of Massachusetts's denied all of my appeals. confused

Posted 5/16/2014 3:06 AM (GMT 0)
Hi everyone--

I haven't posted to this site yet but i have followed it for quite a while. I am in the frustrating appeals process right now. Blue Cross Blue Shield in Upstate NY denied me for the Linx back in February. It is now almost June and with the help of Lindstrom Health Advocacy, I am in the final stage of my appeals process. Fingers crossed!! Anyone get this far in the appeals process and get it approved? Any positive words would be great right about now. I really don't want to have to do self-pay for this procedure but am willing to do so if it comes down to it :/
Posted 7/12/2014 8:56 PM (GMT 0)
I looked up Lindstrom Health Advocacy - they are a California law firm who will give you a free opinion but their services to get your bill paid are not free. We are in FL, so I assume if we have to get a law firm to get our insurance, which is Medicare, to pay, it will cost a percentage of the payment, if they even want to do it since the part that is denied is only the surgeon's fee (about $5,000) - a small amount for many attorneys.

So, I wrote a very good letter pleading my husband's case, laying out the reasons why his LINX procedure was a necessity, including and primarily to get him in line for a lung transplant due to Idiopathic Pulmonary Fibrosis. The physiological link between GERD and pulmonary disease has been extensively studied and the LINX procedure was the easiest surgery for him to have undertaken.

It may be that the automatic response is to deny the coverage and then perhaps to pay on a case by case basis. At least, that is what Mayo in JAX told us.
Posted 12/18/2014 6:07 AM (GMT 0)
Hi, everyone. Im currently having the United Healthcare in California. Anyone has successful got pay for Linx by UHC in Cali?! Any one plz ... give me a glimmer of hope!!!
Posted 12/18/2014 2:29 PM (GMT 0)
maddiehuynh

Welcome to Healing Well.

I used to have UHC and I know they were a real pain to get things approved a couple years ago. Not what you wanted to hear, I know.

If you can get the billing codes from the doctor's office you can call them with them and see what they say.

Take care,
Bill
Posted 1/1/2015 4:33 PM (GMT 0)
LINX surgery is done in india ? Or only in USA/UK ??
Posted 1/30/2015 6:20 AM (GMT 0)
Thank you so much Bill for your response. i'm still on my way getting the result from doctor if im suitable for Linx procedure or not. I talked to several people, they told me they first denied it and after several appeal, they actually got it. I hope that is the case


opnwhl4 said...
maddiehuynh

Welcome to Healing Well.

I used to have UHC and I know they were a real pain to get things approved a couple years ago. Not what you wanted to hear, I know.

If you can get the billing codes from the doctor's office you can call them with them and see what they say.

Take care,
Bill

Posted 4/7/2015 10:42 PM (GMT 0)
I had LINX surgery in Colorado in October. United Health Care sent a coverage approval letter to me for various codes and procedures, including code "43289 and unlisted laparoscopy procedure." I was pleasantly surprised with the approval. The American GI Association lists 43289 as the code for LINX. UHC paid all the various bills quite promptly (total billed to insurance was more than 50K) but have been denying the payment to my surgeon, whose office is in a final appeal-like process with them. If that does not work, then I will follow the patient appeal process. I will not hold much hope for that, as UHC has seemed rather persistent thus far with my Doctor's office, and when I have sent questioning emails. If they do not pay, then I imagine I will have to pay the surgeon, which at the UHC rate of payment would be around $2,500. Again, all else was paid for per my plan. It seems that others are in the same boat. So I feel kind of ripped off by UHC, but the stakes I guess are not as bad as they could be. You would think they would deal with this in a more open and upfront kind of way. Overall, the surgery has proved beneficial. I have not taken acid reducing drugs since the surgery, and while I have some reflux, I can manage it with a Gaviscon or two. It took about 2-3 months after surgery for things to really work properly for me. I can belch and vomit and do not have any bloating issues, which are issues with fundiplication. So I would not claim that LINX is a cureall, but for my very severe GERD, which was negatively affecting my quality of life every day, I will give LINX a thumbs up.
Posted 5/13/2015 4:34 AM (GMT 0)
Well I just got my denial letter from Anthem Blue Cross of Ca. According to Dr. Liphams office, an advocacy group will be fighting the denial for free. We shall see. Fingers crossed!
Posted 5/13/2015 11:05 PM (GMT 0)
Hey DST, thanks for the updates. I'm scheduled for Linx next week. Hoping to have as good of a result as you've had!

K
Posted 7/22/2015 7:17 PM (GMT 0)
Just got the approval for linx and hiatal hernia repair from bcbs of pa. Im having it done at john hopkins by Dr. Marohn. Im scheduled for july 31st.
Posted 3/29/2016 10:24 AM (GMT 0)
@Tsheff18. I am also with BCBS of PA.looking to start up the links approval process this week can you share your process with me along with any helpful tips thanks
Posted 4/18/2016 10:14 PM (GMT 0)
I am with BCBS in Florida.  Has anyone had success with them covering the Linx procedure? 
Posted 5/7/2016 4:41 PM (GMT 0)
I had LINX surgery 18 months ago in the Denver area by Dr. Reginald Bell. Results have been excellent. LINX and Dr. Bell are highly recommended by me! No more drugs or antacids and basically no reflux. Prior to that I had 20 years of reflux misery and a compromised life. United Health Care approved but then backed off that approval post surgery. They wound up paying for most but not all. Dr. Bell has been developing a cash payment option for those who wish to pursue LINX. My life is so much better. So glad I did the LINX.
Posted 9/17/2016 12:47 AM (GMT 0)
Well I have United Healthcare Choice and my hospital and surgeon called to say that UHC won't even pay enough for the Linx device let alone the entire procedure. I have chronic cough from GERD and don't wont the old tie your stomach to esophagus procedure. THIS SUCKS! HATE UHC!!! mad
Posted 1/26/2017 2:35 PM (GMT 0)
Blue Cross/Blue Shield Anthem of Georgia WILL NOT COVER IT nor United Health Care

I was diagnosed with GERD which of course gives me heartburn and a bad cough after every time I eat. Lately I have been even coughing then vomiting up what I ate. The doctors want to install the Linx but neither my last insurance company "United Health Care" nor my new one "Blue Cross/Blue Shield Anthem of Georgia" would authorize it. BC/BS told me yesterday by phone that the reason it was denied was because they deemed it "not necessary." Well, isn't that just fine and dandy that they can say what is necessary or not as they aren't the ones suffering!!

Bottom line is they DON"T want to pay out. Greedy insurance companies!!!
Posted 2/7/2017 11:51 PM (GMT 0)
I had the procedure done at Mayo clinic in Florida 5 months ago. I was told that my insurance BCBS FEP authorized the surgery by Mayo. Two months after the surgery I got a denial from my insurance saying it was not medically necessary. They have now paid some on the device and hospital charges but not for the surgery which was over $12,000. I can't get anyone at Mayo or BCBS to give me any additional information on the denial or why Mayo thought it was approved. I needed the procedure but would not have had it done if I had known my insurance was going to deny it.
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