Question:
Policy Exclusion OR Company self-insured???

They say "policy exclusion," but, the wording in the policy is it WILL be covered if medically necessary, and I have several documents stating it is. Would they tell me if my husband's company is self insured? Its a huge company, Walgreen's, but I need to know if fighting the insurance company will be a waste of time. Can my husband ask his Human Resources person...or should I call my insurance company? I'm prepared for battle, I just need to know who to battle with! Any suggestions???    — [Anonymous] (posted on September 13, 2000)

November 9, 2000
Your human resource person can verify if your husband's company is self-insured -- if so, your husband's company can make an exception to allow this procedure if it has been determined not medically necessary by the insurance company - when it is a self-insured group the insurance company is limited to what the policy holder (employer ex. Walgreens) stipulates.
   — [Anonymous]

December 12, 2001
The answer above is not correct. Even self-insured companies have contracts with re-insurance that run for a plan year. Walgreens may have to get approval from re-insurance or wait unitl the plan year end...or risk the expense of paying a catastrophic claim out-of-pocket in the event that there is one without re-insurance approval.
   — [Anonymous]