question about insurance commissioner.
hi family I have a question I was denied wls due to an exclusion, 7/2004, any treatment to reduce obesity, but no limited to sugerical procedures. So after I was denied the first time , i appealed 11/2004 , then had a grivance meeting 12/30/04 . denied again. So I was advsd by Humana that I would have to appeal to insurance commissioner did that, 5/17/05 they told me I had to wait for 4 to 6 week for the results. If my emplyer is self funded erisa . What happens , can the insurance commissioner still approve. I asked my Hr what does erisa mean she sent me the definition but I just really didn't understand. I have a really good appeal. I am fighting them with , super morbid my bmi is 70.5 and also I have 2 different certificates of coverage. with different exclusions. I also have emails were my hr dept told me that the plan that I am currently under hasn't change in 8 years . I have 2 plans with differnt date that say other wise. So I am fight on that 2 . I am fighting also instead of super morbid obesity but my co morbities . Can the insurance commissioner do anything?
IF you don't mind me asking, who is your employer? I was wondering if you work for the state of Wisconsin like I do. If so, I had to leave Humana and go with the state's Blue Cross Standard Plan. The HMOs have an iron-clad contract against GB. I switched to the BCBS after going up to the insurance commission myself only to be told no. If your employer has a self-insured plan, you may have to switch to that like I did. IT is the most expensive plan, but the only way I could get the surgery. Much love and much success to you.