Overturning Surgery Authorization Denials

Too often, lymphedema patients in need of surgery are denied authorization to proceed by their insurance company. This is after months or even years of working to identify the issue and find the right doctor and treatment plan. This leaves patients devastated and confused all while battling the physical pains of their disease. At this point in the process, patients have two options: take on their insurance company in an expensive and stressful legal battle or resign to live in pain while seeking alternate, less effective treatment. 

At the Granzow Lymphedema & Lipedema Center, we don’t believe that’s right, which is why we do things a little differently. We have an in-house Patient Advocacy team, at no extra cost to the patient, that will fight to get you the coverage you deserve—at no charge to you. Led by the Director of Patient Advocacy, Amy Granzow, this team offers services you can’t find anywhere else. 

Meet Your Patient Advocates

“I was working at a large law firm downtown when I met Dr. Granzow,” says Amy. “He was feeling extremely frustrated by the number of patients who were denied surgery authorization and after hearing his stories and looking at his patient cases, I knew I needed to help. These patients were being denied treatment unjustly and unfairly, so I immediately started taking on his cases and overturning denials for patients.” 

Since then, Amy has become a full-time employee and has added a team of experts to work on appeals for our patients, fighting to ensure everyone is given the coverage they deserve. 

“Insurance carriers typically deny surgery requests for one of two reasons,” claims Amy. “They either don’t believe the surgery is medically necessary or they don’t believe that the surgery is a proven solution, but rather an experimental or investigational procedure. In my book, neither argument holds up.”

Amy and her team aren’t just your insurance advocates—they are a true partner in your overall care.

 Caring for Your Medical, Emotional and Insurance Needs

When surgery is denied, patients need a partner to help them navigate the appeals process. And that’s what our Patient Advocates are here for. We work with you to assemble the strongest possible case in an effort to achieve a positive outcome. 

“We believe very strongly that patients deserve the right kind of support during their surgery authorization process,” explains Amy. “Our department ensures patients get the care and answers they deserve.”

The team has extensive experience guiding patients through the appeals process. They work together to provide coaching and advice, advocating for our patients, whether the patient is seeking surgery authorization or reimbursement. And if the team is facing a particularly challenging case, they tap into our network of healthcare advocates across the U.S. to collaborate and problem solve to find new solutions for our patients. 

Experience that’s personal

Not only does Amy have years of experience winning cases and representing patients in court, but she has been personally involved in legal battles with insurers to ensure her daughter, Cora, receives the care she deserves. 

“My daughter suffers from a severe genetic disorder, Angelman Syndrome,” explains Amy. “It was a long, arduous journey to obtain the diagnosis, so I understand the anxiety, fear and anger that comes with being treated unjustly when it comes to your health. Cora is non-verbal, so I became her advocate, taking on the insurance companies to secure the care she deserves. I believe I became a much better advocate for our patients after that experience because I could relate to their struggles on a very personal level.”

Amy wasn’t satisfied with mediocre care for her daughter, and she won’t stand for mediocre care for our patients. So she fights for the best.  Director of Patient Advocacy, Amy D. Granzow, with her daughter.

She and the team understand that the battle for appropriate healthcare is a very personal one. Patients are already vulnerable when dealing with lymphedema, and then they’re told by their insurance company that they don’t have a voice in their own care. So our Patient Advocates take on that responsibility, using their ferocious voices to take on the big insurance companies that don’t play fair. 

It’s this tough attitude and determination that allow our team to overturn surgery denials. And when we get a note from a patient expressing their gratitude for winning approval for their surgery, it fuels our work and encourages us to continue the fight. 

Most common patient advocacy questions 

While the appeals process for each patient is unique, there are some aspects that remain consistent from case to case. In fact, when we first begin working with a patient, they often have the same three questions, which are:

  • When will I get my approval?
  • How successful have you been in reversing an insurer’s decision?
  • How personal does my testimony need to be?

When will I get my approval?

We know this isn’t what patients want to hear, but the truth is, timing varies quite a bit from case to case. We have patients in very similar situations, but some get approved quickly while others are left waiting for months. We often don’t know why certain cases experience longer delays than others. But in cases where employers need to get involved, their support can sometimes influence how quickly approvals are obtained. Some employers are very supportive of their employees and help them fight for what they deserve, while others lack the understanding of how devastating lymphedema can be, and they’re more reluctant to help employees. In either case, we’ll do everything in our power to keep your case moving forward in a timely manner. 

How successful have you been in reversing an insurer’s decision?

This question we can answer more positively. Our incredible Patient Advocates to date, have had a good success rate at getting denials overturned for both California plans and plans outside of the state. That’s thanks to the tireless work and brilliance of our Patient Advocacy team as well as the patience, understanding, and efforts of our patients.  The appeals process is a collaborative one and we are most successful when our patients work with us to assemble the strongest case possible. This brings us to our third most asked question. 

How Personal Does My Testimony Need to Be?

We understand how difficult it is to open up about your personal struggles with lymphedema. During this process, you’re asked to revisit the most difficult, challenging times in your life, including relationship struggles caused by lymphedema and the day-to-day difficulty of keeping up with your kids or grandkids. 

Though we see this hesitancy to open up in many of our patients, it is especially common in our male patients. There’s a resistance to showing vulnerability and exposing your daily struggles, but it’s often a necessary step to achieving an approval.  Our Insurance Authorization Specialist states,

“We ask our patients to write a personal letter that speaks to their specific journey inclusive of attempted conservative therapies, the toll of emotional and physical pain, and the effect that lymphedema has made in their daily lives, which is then presented to the insurer to help convey how the recommended surgical plan will provide the patient with hope of returning to a more normal life.”

Our team provides extensive expertise and works hard to look for precedents that will support your case. But only you can speak to the ways lymphedema negatively impacts your quality of life. We tell patients that when writing letters, it’s important to share how difficult it is to get up and deal with compression garments, explain how challenging it is to shower, cook and even walk. You have to make the person reading your letter understand what your life looks like now and how it could change for the better with the right treatment. 

In our experience, the cases where patients are willing to speak to their most vulnerable moments tend to be the most successful. 

Are you looking for a comprehensive partner in treatment and recovery? Schedule a consultation with the Granzow Lymphedema & Lipedema Center and get the treatment you deserve.