Question:
Anyone know how I can find the phone number for Wisconsins insurance commissioners

office. I am posting the question that I put to the message board. any input would be greatly appreciated. This is going to be long and rambling. My surgery that was scheduled for next monday the 10th has been canceled. I got a call yesterday from BTC. My insurance has put a hold on my approval. I work for a company that has self funded insurance. Last week the front office found out that I was having surgery and what it was for. On Thursday someone from my comany called their insurance broker and told them that I am on some kind of program or diet and I am losing weight, so they should put a hold on it because maybe i don't need the surgery. since my consult on Feb 1 I have gained about 12 pounds. Someone has decided that they don't want to pay and has lied to their broker to see to it that I can not have the surgery. Insurance company asked me which of my Dr.s would have the best documentation of my weight. He is going to get records faxed to him and forward them on to the people that are to review it. I hate feeling this sinicle but I just know that my company is going to do everything they can to make sure this doesn't happen. Can my employer change our insurance policy in the middle of the plan year? There is no exclusion in my policy. I was already approved. Does my insurance company have to tell my employer what medical treatments I am receiving?I have the feeling that my employers are probably social friends with the insurance broker so they are probably working together. I am so filled with anger, hate, rage, and resentment right now it's literally making me sick. Has anyone had a similar situation? I can't believe I have to fight with a company I have been at for almost 9 years. We are not union so I am under the impression that they can do almost anything they want to us. I will try to calmly wait until it has been reviewed and see what happens. If they refuse I will probably quit my job. I don't think I could continue to work for people that would do this. I was about to have just what I have been praying for and it was pulled right out from under me. And of coarse nobody at work has had the guts to say anything to me about it. Nobody asked me if I was losing weight or anything. The person that did this probably never thought twice about it. Never considered what they were doing would actually have an effect on someone. Just making sure that the money isn't taken from there wallets. Anyone know if a self insured company can refuse this even if the insurance company has already approved it? Thank you in advance for any advice or input. Janine -- Janine Scharr    — Janine S. (posted on June 4, 2002)

June 4, 2002
Hello there. Let me begin by saying that self-funded insurance is pretty tricky. The way it works is that Your Employer basically pays the costs of any procedures that you have. They would outsource claims processing to a third party administrator who takes care of sending you the Explanation of Benefits and processing the actual claims, however, the Employer pays for the services you receive. Basically, each month, the insurance administrator would send your employer a list of claims approved and paid by them, your employer would in turn cut them a check. By going self funded, your company is saving a great deal of money, at the same time, they are in control of the claims being paid. Whoever maintains the insurance at your company, be it a benefits directer, etc. will be advised of any large claims and chances are, your employer does know what their employees are being treated for, etc. While there are privacy rules under HIPAA (Health Insurance Portability and Accountability Act), those regulations aren't final until April 2003, HOWEVER, Your employer should not be sharing confidential medical information w/a broker or any other type of insurance agent. They CAN contact their broker for advice on situations, however they should not be providing too much information to them. They should only be dealing with the insurance administrator on claims issues. Have you spoken to your employer and asked them why they provided confidential information to the broker? Has your employer advised you that they amended the plan? Generally, any major changes to a plan can only be made during the annual plan renewal. I'm fortunate that I've worked in benefits for a number of years and I'm also lucky that my company offers an excellent plan, that's also self funded. If I can be of any help, please let me know. P.S.If you go http://oci.wi.gov/com_form.htm, you'll be instructed on how to file a complaint w/the WI Department of Insurance
   — Rosario T.

June 4, 2002
I work for a doctors office and I have a list from 1999 with the state contact persons, hopefully this helps - Call David Cauffman at 608-266-3585. Best of luck to you!
   — Sandra D.