Self funded Insurance/denials

The insurance we have is with the City and it is "self-funded" with an exclusion on any WLS. I was wondering if anyone had any ideas on how to beat this? I have been to a Dr and he wrote a "medically necessary" letter to the insurance & it was denied. (that was expected). Our insurance is BCBS of Texas, but they only handle the paperwork for the City. I am so ready to have the WLS, but I have yet to meet with a surgeon cause I feel that Im supose to get approval first from insurance/City. My husband supports me 110% and wants me to fight this...any ideas? Please reply or email me, I would appreciate any assistance on this matter. God Bless, Traci [email protected]

I use to work for a city that was also self funded. We processed our own insurance claims (did not use a third party for that) ONE thing I can tell you is that THEY (the company) can approve or pay for anything they want (in reality) THey may say 'they cant' but they do; and also sometimes office politics can pay a part. Since they do use BCBS as a TPA - have them 'review' the claim. Even tho we processed our own; we had BCBS 'review' cases' for medical necessity etc. SINCE it can be a possiblity (it was in ours) that the person running the RISK management department is NOT medically trained. If that fails, have your husband go to his supervisor and have 'his' supervisor talk with the Top people; or you can request a meeting yourself directly with the Plan admistrator. If that fails, espeically with the city, they usually have a 'board' that mets and you could appeal to them. I have seen things 'paid for' that were NOT in the plan. It can come down to who you know.