appeal self-funded insurance plans?
I have a self funded plan and had to appeal over a period of a year and a half, 3 times on 3 different denials directly to my HR dept.
However; there was no exclusion to WLS as it is covered under my plan.
Sometimes if it's it not covered, it's just not covered.
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Proud Mom of Brantley Alexander, 6 1/2 years old .
"CoCo" November 2009,
July 2010
I think that if WLS is specifically excluded from you health insurance then there is no way to get it to cover the surgery. If it was a covered benefit that was denied for some reason, then you can appeal. But, if it's not covered at all due to an exclusion, then there's no way to appeal what isn't covered. Maybe next year at benefits renewal time they might consider adding WLS as a benefit and stop excluding it?