tips on exclusions

I think I am being quite educated on fighting a self funded plan for an exclusion for gbs. After 6 months of ups and downs. I am finally getting close. Here are some tips for people who have been through appeals, board reviews, and in the end told no. 1. Go to the boss who you work for, or in my case the superintendent of the school. Get that person on your side. Educate people about MO 2. Write or better yet call you local senator. 3. If by any chance you are affiliated with a union. Call, and immediately. Most people don't know they have so many hours of free counsel with their unions with insurance problems. 4. Are you being denied for what you consider a disability due to your MO If so then get in touch with Fed Health and Human Services, or DOL 5. Go to the Ceo of the insurance. If you found your reviews, appeals, not to be full and fair. Talk to the chief of operations. 6. In illinois the Attorney General has a hot line for bad faith claims or any other kind of insurance problems. 7. Know and memorize the american disabilities act. And the HIPPA laws. What I have learned, without jumping off a bridge is; insurance is all about money for some self funded plans. Exclusions must have certain wording. Exclusions are overridable, and can be issued a waiver. Exclusion can often be discrimination to many individuals, if the denial of the health claim is based on withholding treatment which could very well improve or eliminate your disabilities from morbid obesity. If we do not fight the system, the system will not change. To date I have a union rep going to arbritration on my behalf. An employer trying to obtain a waiver, or EVEN SWITCH TO A BETTER INSURANCE. My probelm was the TPA and how they operated. I will not use names. They broke regulations, and processed my claim in bad faith in my opinion. I realize this is long. I only want to encourage you to never give up. That is what they want. Try and work with someone on the insurance level who you can win over, sometimes that's all it takes. But in the meantime educate yourself on your rights. And exercise your rights. I am not authorized or even sure if I am going to get this surgery. I am a week or two away from that answer. People donn't even try if they know they have an exclusion. You have to prove the reason why this MUST BE DONE. Don't take no for an answer. Hope this helped. Barb S.

Thanks for the info Barb!! Shelli