Self-funded insurance and exclusion

Shannon N.
on 3/23/09 12:25 pm - Livonia, MI
My husband's insurance is self-funded through BCBS MI.  I know BCBS MI usually covers WLS, but my husband's contract says it's excluded.

Has anyone ever talked to an HR dept. and gotten them to change the contract?  I know it's a long shot and I don't expect it to happen, but I am just curious if anyone has gotten a company to change this?
Shannon
Surgery weight: 322
Highest weight: 360 (2004ish)  

     
rjsmommy
on 3/24/09 5:17 am - Youngsville, LA
Hi Shannon
I work for a company that is self-funded. Our policy covers wls however it didn't cover the surgery I wanted, VSG, so I appealed the first time to BCBS of LA and they upheld the denial. My 2nd level appeal went to the Director of Risk Managment in our HR department, they approved me for it and said they would cover the costs. So I would atleast try. Maybe see what the appeal process is like and if you would ever appeal directly to the HR department I say DO IT!! I wouldn't be having surgery on April 14th had I not.
Because the policy is self funded the HR has the final say.

Best of Luck
Jess





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