Insurance Guru: Please help

I am in a battle with my human resources department at work.  The doctor that I want to do my RNY is covered under the "umbrella" of my insurance but is not covered on my work's "group plan".  My group plan does however cover the surgery of RNY.  We just have no providers to do the surgery.  What do I need to do to get this covered?

What health insurance company do you have, and what state are you based in. 

Without knowing further inforamtion, I would file a written request to your carrier asking for a list of physicians that they would consider network.  If there are no network physicians - request an exception be made for this surgeon. 

I live in Georgia and I have UMR health insurance which is under the First Health Network "umbrella". 

The doctor I chose to use is Steven Webb in Jacksonville, FL. He is covered under First Health but not under my UMR group plan. 

The surgeries covered under my group plan are Lap Band, Stomach Stapling, and gastric bypass.  Only 2 bariatric surgeons are covered under this group plan and they only do the Lap Band. 

Gastric Bypass is a covered benefit but we are given no providers who can do this surgery.

I have met with the HR director and have an appointment with the CEO of my company (I work for a hospital).  I am tired of waiting for someone to act on this information that I have provided to my workplace.  So I have followed the chain of command at work and am going to see the big man next week.  Someone is going to provide me with what I need.  I am not giving up.

UMR appears to be a TPA which means they are self funded.  Generally that means that state mandates (most of them anyway) do not apply, but federal mandates would.  Ask them for the name of a network provider who will provide the services that are covered under your contract.    If you cannot get an answer - you can contact the GA Dept of Insurance - they have a place on their website where you can submit a general question.  I would ask them if there are any rules regarding access availablility if your carrier does not have a network provider.

http://www.gainsurance.org/Other/QuestionEmail.aspx?T=EQG