Question:
Has anyone been approved by a self-insured company?

I work for Parker Hannifin Corporation. I don't know if anyone else out there works for Parker, but it would sure help to get some info on self-insured companies.    — Mary J. (posted on August 7, 2000)

August 7, 2000
Sharon, I work for Menninger Psychiatric Hospital and they are self insured. This surgery was excluded on the policy. Here is what I did. First my dr sent a letter to the insurance company and I got a denial letter back. I then checked with Human Resources to find out what to do. I was told to contact the "System Administrator" who happens to be the Director of Human Resources. I called her and talked with her. She told me step by step what to do. I sent her a letter asking for an exception to be made to the policy for me because this surgery is medically necessary. I started this fight in January and talked with the System administrator about twice a month. Eventually she told me that they were denying my request for an exception but I had also made a request that the insurance policy be changed. That request went before the Board of Trustees in April and they agreed that it was necessary to get more information and see if they would consider making a change. I helped the system administrator gather information. I e-mailed her everything I could find. Finally in May the Board met again with the gathered information and they agreed with me that the exclusion was outdated and needed to be changed. So now Menninger requested information for several different places on Costs to do the surgery vs not doing it,What the impact would be on the plan etc. In late May that information was back and they decided that a change definately needed to be made. Then that had to be approved by Dr Walt Menninger and then by a management group of Menninger employees. That was finally approved in late June and July 1 the new policy took effect. My surgery is scheduled for August 18. Best of luck to you. Fight for what you want, just remember if you don't fight for you neither will anyone else.
   — Jeannette S.

August 8, 2000
Hi Sharon, I, also, work for a company that's self-insured. They do have an exclusion in their policy for "weight loss medications and/or programs...". However, the sentence goes on to read, "...except those in connection with surgery necessitated by a diagnosis of morbid obesity". They covered my wls with no problems and I was approved within 17 days of my surgeon's initial request. Like Ray said, it's the company that determines the benefits, not the administrator of the policy. I don't know if a direct appeal to the "powers that be" in the company would help if you're denied, but I had already written a letter to send to them had that been the case with me. I would also have made an appointment with the president of my company to speak to him directly. I was pretty determined and would have gone to practically any lengths to at least be heard. Good luck. cj
   — cj T.