Question:
Appeal to a self Insured Company

I am employed under a "Self Insured" company. The Claims are administered by BC/BS of Minnesota under a contract between my employer and BC/BS of Minnesota. There is a written exclusion under the plan for "Services for or related to weight loss programs and all associated labs and physician visits, program fees or dues, nutritional supplements, food, vitamis and exercise therapy" also "Endoscopic and surgical procedure to treat morbid obesity, including gastric bypasses and jejunal bypasses. I am going to send an appeal directly to my employer at the main headquarters. Any advice aside from doctors rec's and medical information I should include. Has anyone else done this and been successful? Thanks for your input...    — [Anonymous] (posted on November 6, 2000)

November 8, 2000
I too work for a company that is self insured. My company also had an exclusion on the policy. I appealed to the "System Administrator", I told her my story and why I needed this surgery and then I sent her everything I could find (good and bad) about this surgery. She then took all of this information to the Board of Trustees. They ended up denying my appeal on the exclusion but they agreed that the exclusion needed to be changed completely. I started this process in December 1999 and in July of 2000 the insurance policy was changed and I had my surgery August 2000. It worked out better than I thought it would when I first started because my goal then was to get the surgery for me and instead I helped make it possible for anyone who works for this company or their dependents get this surgery if they need it. Don't give up and just keep in mind that it may take a long time (or at least it will seem long).
   — Jeannette S.