Question:
My appeal is denied. Employer is self-insured in MD. Help?

After waiting 3 more months, my appeal has been denied. Husb. employer is self-insured which apparently in MD exempts it from Maryland's law on obesity surgery. What can I do now to get it covered? To say I am down is a real understatement. I honestly thought it would be approved. Thanks.    — AJC750 (posted on February 19, 2002)

February 19, 2002
First find out if there is another level of appeal. If there isn't, find out who is at the very top of the pyramid. Make a personal appeal to that person. That's about all you can do ad far as getting group coverage. Can you get a second mortgage...an advance on an inheritance. Is there a family heirloom you could sell? My best friend sold her car and her engagement ring to finance her rny. She's driving a clunker and wearing a cubic zirconia...but she looks terrific and has has a long, healthy future ahead of her.
   — [Anonymous]

February 19, 2002
I have read on this board that some have made a personal appeal to the self-insured employer. You could consider an appeal to the head of human resources or the CEO of your husband's employer.
   — [Anonymous]

February 19, 2002
this might be of some help, there are these "bandsters", on yahoo, they went down to mexico, and had the lap procedure done for something like 6500, including air fare, so, perhaps thats an alternaitve. I will find out tommorow if Im approved or not. But that is my back mexico is my back up plan. I will pray for you, that you will succeed, please pray for me, thanks,
   — amy T.

February 19, 2002
I was in the same boat as you were with self insured policy that claimed they were exempt from state laws. (Only in Michigan instead of Maryland). I hired Walter Lindstrom to handle my second appeal and I was approved within 3 days of his submission of my appeal. I highly recommend Walter and the cost was only $350 and worth every cent. A lot less than a self pay WLS or a trip to Mexico, which I would never recommend as long as you have any other options. Good luck and don't ever give up. That is what the insurance wants you to do.
   — Dell H.