Aetna Denial- Insurance Commissioner Poweless!

I posted this on the main board... sorry if you have read it twice! A while back I had posted that I was denied by Aetna. Someone advised that I should contact my Insurance Commissioner's office and have them help me with my appeal. I contacted to them, and to their credit, they went to bat for me. They called Aetna and tried to help with my appeal. Sadly, I was denied by Aetna. After my last denial, they sent me this letter in response. I hope these helps others who are fighting Aetna. If your insurance company is self funded, and I had no idea my company was, they are powerless. I work for a very large company with thousands of employees across the world. I don't know what my next step is, but I only have a short time to plan it. This is the letter the insurance commissioner of Georgia sent me. It is verbatim except I removed my name, the name of the investigator helping me, and my place of employment. ------------------------------------ Office of Insurance and Safety Fire Commissioner of Georgia John W. Oxendine This is a follow up to my letter dated __________, 2004. As previously noted, Aetna was reviewing your appeal for denial for precertification of Gastric Bypass surgery. I have received a copy of Aetna's response to your appeal. Regrettably, Aetna has upheld their original denial of benefits in this case. Aetna has also indicated that the health insurance plan that covers you through your employer, _______, is a self funded plan. Self funded plans are not subject to insurance laws of the state of Georgia. These plans are subject to the jurisdiction of the U.S. Department of Labor in accordance with the 1974 Employee Retirement Income Security Act, known as ERISA. This particular ACT established guidelines for self-funded plans and exempted them from state insurance laws and regulations. Any further questions regarding this plan should be directed to your employer and/or to the U.S. Department of Labor at (404) 562-2156 or toll free at 1-866-444-3272. If you are interested in filing an ERISA appeal with this company, you should follow the guidelines listed in your employee handbook. This letter from Aetna in response to your appeal outlines further appeal rights that are available to you. You may also wish to consult with a benefits representative at _________. The employer is the claims fiduciary; thus, the authority for final determination of any issues involving the payment or nonpayment of claims rest with the employer. Ms. _____, I regret that our office lacks the regulatory authority to resolve your concerns. We appreciate having been given the opportunity to review your concerns. Sincerely, ______________

I'm new to the board, so forgive me if I ask a question that has long ago been answered. Are your HR people totally unresponsive to your situation? Is there someone higher up the ladder in your company who could be appealed to with the rationale for the surgery? Lastly, have you been with them for a long time, or would it be possible to go with a company that has the right insurance? Another thought - isn't it possible to use IRA money for medical expenses? Of course, that would be coming out of your own pocket, but at least there wouldn't be a penalty. There just has to be some way. You really deserve this. Barb in S. Georgia