Walter Lindstrom's Eugene Speech

[Guest guest]

Hi All - I received several requests to post this here, as well as

on the Welker list, so I will in the hopes that you will find his

talk as interesteing as I did -

On Oct 16, Walter Lindstrom came to the monthly support group

meeting (PRIDEgroup) for Latham Flanagan's patients in Eugene,

Oregon. I was hoping someone would be reporting on this here,

because he did a terrific job, and spoke to many things we all need

to think about. It's been a wildly full week for me, but I did want

to get a report back to those of you who weren't able to attend.

(and most of you know that, unfortunately, I never seem to have too

FEW words, so it's another looooooooong one... but I must stress that

he had some very important messages for ALL of us, not just for those

still hassling with insurance coverage, so at least skim through if

you can...)

Walter is a delightfully approachable, charming man, and his

speech was a pleasure. He wears one of those 5 " round buttons you

can have made at a fair, only his has a picture of him at his pre-op

size - somewhere over 400# - as a reminder to himself of the journey

he began 6 1/2 years ago.

He told us that, as a new lawyer, he had found himself stuck in

back rooms working on things which didn't interest him, for the same

reason that he and his wife were experiencing fertility problems -

his morbid obesity. The first time he received a denial from his

insurer, he did what most of us used to do - just accepted that he

had no right to the surgery, and walked away. A few years later he

and his wife adopted a child, and he found himself unable to do any

of the things he needed to do as a parent; this time, when he went to

a (now different) insurer, he didn't take " no " for an answer. His

winning his case on appeal turned out to have been the turning point

in his life which saved his health AND shaped the direction of his

entire career. He took the plunge, went out on his own and formed

the Obesity Law and Advocacy Center. It's the only firm of it's kind

in the country, and now employs two lawyers full time.

Walter says he holds the deep belief that insurance companies

wrongfully, knowingly, maliciously and dangerously withold care from

the morbidly obese. He's especially frustrated with companies which

demand that the patient display UNcontrolled diabetes or

hypertension, noting it would be pretty amazing if they forced cancer

patients, for instance, to get to the end of their lives from one

treatment before they considered an alternative. He believes these

companies might just as well be saying to us " Just go away somewhere

and die. "

The title of Walter's speech was " Heroes. " He believes the

people in that room, and these support groups, have the

responsibility to change the way the world sees obesity and the life-

saving possibilities of these surgeries. We know all about our

unique situation and needs, but people who haven't dealt with them

don't know, and we must teach them. Just as the world has changed

it's opinions, and actions, about AIDS because some were brave enough

to make their plight known, so too must all of us spread the true

information about this disease and its possible cure. He said every

person in that room (and on this list!) is - or could be - a hero,

from the loved ones who are our hand-holders after surgery, to the

people who actively fight the insurance companies with persistance

and patience, and especially those of us who can openly talk to lots

of people and admit what kind of surgery we had and how important it

is.

He asked the group several questions about actions they could be

taking as " heroes " to this movement -

- How many have followed up with your insurance companies AFTER

your surgery, sending them thank-you's and before and after pics,

telling them how great you're doing, saying things like, " I used to

have to use a C-PAP, " or " Now I can play with my baby, " or " I no

longer have to take insullin (or hypertension meds or... " ) or " Now I

go to the parent-teacher conferences, since I'm no longer afraid of

humiliating my child, " etc. They need to HEAR from us that we're not

only grateful that we were given this tool, and that we've worked

very hard to use it, but also that it DOES actually produce all that

was promised.

- How many of us have actually " come clean " with fellow employees

and family members, and told the TRUTH about our surgeries instead of

seemingly losing hundreds of pounds " magically, " from what we called

a " gall bladder operation? " Walter reminds us we need to TELL people

- spread the word. Maybe your co-worker has a mother, father,

sister, friend, someone who will die prematurely because they never

heard of this surgery. The world had a desperate need to know about

this - stand up and be proud and change somebody's life!

- How many know anything about the changes being proposed

liegislatively? (Georgia law now states that any insurance company

NOT covering wls is ADDING to everyone's cost of coverage!!) Oregon

is one of the worst states in terms of insurance compliance on this

issue, but there is change happening (and/or proposed) here and

elsewhere. Have you spoken to your representatives? Do they know

you want them to support legislative change?

- Who buys insurance policies? Let your employers know how

important this is - and why. (Are they aware there's a tool actually

available right now which cures diabetes, cures hypertension, let's

the patient throw away C-PAP machines?) Few of the people who make

decisions about buying these policies have any idea that there are

exclusions as part of the package (and never are really given the

choice to exclude), and need to be educated on what to look for and

why to pay for it... though in many cases is costs the company no

more, it's just a matter of knowing what to look for. This goes for

ALL sizes of companies!

- EVERY time you have a problem with an insurance company dealing

with bariatric coverage issues, contact your state department of

insurance! Rocky King is the head of that dept. here in Oregon, and

he, like so many in that job, remains woefully uninformed about the

benefits of wls. Maybe if he got all of the above POSITIVE feedback,

he might loosen up his strict denial policy.

The cause is just, we all know the benefit. MORBID OBESITY IS THE

SECOND LEADING CAUSE OF PREVENTABLE DEATH! If we want this, and want

others not to suffer, we MUST spread the word. This is not a popular

cause, so no one but we who suffer from it can do this which needs to

be done.

Walter suggests that each of us join the American Obesity

Association (@ obesity.org) to have a voice in a larger organization,

too.

Walter ended his speech with the presentation of the first ever

Humanitarian Award given by Obesity Law and Advocacy Center, and a

lovely plaque, which he presented to Latham Flanagan in recognition

of his many years as caring, compassionate warrior in the fight for

obese patients. Dr. Flanagan received the standing ovation he richly

deserved.

A Q and A period followed, with Walter responding to the following

questions:

Q: Is the differentiation between the terminology for " obesity "

and " morbid obesity " (ie: a policy will state denial of treatment of

any kind for " obesity, " but not mention " morbid obesity " at all)

useful in coverage denial?

A: Works sometimes, sometimes not. Since the ICD-9 code for

obesity is 278.00, and morbid obesity has its own distinct code of

278.01, this is an arguement which can be used - especially since

surgery is NEVER done if the code is only 278.00, yet the AMA now

recognizes surgery as the only thing known to work for 278.01. He

noted that this has worked not nearly as often as he'd like in

Oregon, which is not as consumer-friendly.

Q: Is a class-action suit possible?

A: He has just filed one against BC/BS of Texas, also looking to

do the same against ODS in Oregon (he introduced , an

attorney from Eugene who will be working with Walter on this. He

asks that anyone who has had. or is having, ODS problems submit all

the info to him.

Q: On an appeal, does it help to list monthly costs associated

with pills, etc.?

A: This really hits the heart of the problem - insurance

comapnies these days expect an insuree to be part of their system for

only 2.5-2.9 years before either they move on to another job or their

company picks another insurer. So they really don't CARE about your

projected long-term costs - or probable mortality. Thy are motivated

strictly by short-term cost savings. Why should they want to save

money for their competitors? That's why uniform legislation is so

important - if all of them HAVE to cover it, then it benefits all of

them, too. Walter did add that, in face-to-face appeal meetings, he

asks his clients to bring the full dog-and-pony show, because it's

hard to ignore the C-PAP machine and the 17 pill bottles lined up in

front of them - this is MUCH more effective.

Q: Is there a statute of limitations on going after reimbursement

after one has been denied, and had the surgery anyway with self-pay?

A: In California it's 4 years, but he suspects it's probably no

more than 1 year from date of surgery in other states - this info can

be gotten from state dept. of insurance.

Q: Can he " practice " here in Oregon?

A: Only in colaboartion with a local attorney, on larger

matters. He can, however, do everything " up to but not including " a

lawsuit in states other than his own (CA)

Q: Any " good " insurers he'd reccommend "

A " He's the worst to ask on this one - he only sees the bad

guys! He has had good results with Providenc here in OR, hasn't lost

a case to them, and hasn't heard much lately, which may mean they've

changed how they cover. (He tells clients to check with the offices

of doctors such as Flanagan or Welker - who also attended the

meeting, and was warmly praised by Walter for his efforts on behalf

of his patients - because they would know best who in each area is

the best responder). Also he reminds to check the insurance portion

on Obesityhelp.com, by state.

Dr.Welker was just appointed head of the newly instituted

Insurance Committee for the American Society of Bariatric Surgeons.

He noted that he's been working with Regence, of Oregon, who have

been " re-evaluating " their policies and would support state-wide

legislation. Dr.Welker also has managed to get Regence to include the

DS as the accepted procedure - a first!

There was a lot more after the meeting, with Walter answering as

many individual questions as he could, and it went on quite late, but

I wasn't privy to those conversations. As you must be able to tell,

I was VERY impressed with Mr.Lindstrom, his committment to this

problem, his professionalism, and his humanity. Would I seek his

services if I were to need them? In a heartbeat! Marti (with

apologies to Walter if I've misquoted - I'm sure he'll correct me!)

Also, a quick thank-you to all the kind folks who have given me

so much good info here - I'm scheduled for Laproscopic DS surgery

next Tuesday, Oct 31, with Dr. Welker at OHSU. (Ht. 6', Wt' approx

380, BMI 53/54, age 52, Insurance - The Guardian PPO - responded

positively within 3 working days (I know, I know, I'm one of the

really lucky ones) Marti