Question:
did anyone go through HR for approval?

I'd like to hear from anyone who was denied through their insurance that was self funded and then went through the human resources dept for approval. My insurance is BCBS of IL PPO and they have denied me 1 time so I contacted the IL dept of insurance and they told me since my insurance was self funded through my husbands employer that I needed to go through the HR dept for approval. Any advice would be appreciated, Thanks!!    — DoxieMom72 (posted on March 19, 2004)

March 19, 2004
I have BC/BS of IL PPO and I did give my HR a call. They told me I had to follow what Blue Cross wanted...a 6-12 month supervised diet. They were not much help to me. But don't let that stop you. Give the HR dept a call and hound them about it. See if they can get Blue Cross to budge.
   — Kara J.

March 20, 2004
I am currently dealing with a similar situation. I had surgery 3 years ago and I am trying to get my 19 year od daughter approved. We are self insured through a school system. The insurance company denied her the first time and I appealed. The second letter of denial came from our business manager. I appealed again I just recieved a letter saying that a second Dr. had reviewed the request and denied it again. They have never really given a reason why. She has a BMI of 40, she is on thyroid meds and has been diagnosed with knee problems. Several other people under this plan have had the surgery. My business manager has publically stated that he thinks she is too young. I have requested legal representation through our union. I am finding that the rules are very different for self-insured employers. The HIPPA confidentially rules don't work the same way either.
   — Lisa P.

March 20, 2004
Back in the late 80's I had the same thing. They didn't budge. I found out after I quit (a few years later_ another girl had Walter lindstrom write a letter screaming discrimination etc. They not only approved her but changed their policy and WLS was part of the medical plan.
   — ZZ S.