appeal self-funded insurance plans?

raven99
on 3/28/08 7:17 am - Highlands Ranch, CO

My insurance is self-funded by my husband's employer.  They use United as their 3rd-party administrator.  Of course, we have a written exclusion for wls. Has anyone appealed to an HR rep and received an exception?  Any advice appreciated!

Cathie N.
on 3/28/08 10:15 pm - Augusta, GA
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.

 Proud Mom of Brantley Alexander, 6 1/2 years old .
"CoCo" 
  November 2009,   July 2010

  
Shelly H.
on 3/29/08 2:45 pm - Norman, OK
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? 
Vicki Browning
on 3/31/08 11:24 am - IN
Raven  as a self funded group your husbands employer actually calls the shots.   All United is doing is the administrative work.   You have the right to appeal with the HR department and if you need help in writing an appeal to them I would be glad to assist you in this matter. Just PM me.  Vicki
Telbereth
on 4/2/08 2:52 am - SW , MO
Do you have information on the complication rates of the surgeries?  That is what what my HR keeps throwing out....apparently BCBS of TX is telling them that but I think it is very old info.
Beginning My Real Life

A Work in Progress

Most Active
×