Question:
Has anyone had success getting their employer to ask insurance to cover surgery?

My husbands employer participates in a "self-funded" insurance plan and I was told that the employer can request that the surgery be covered. If you have gone this route, please let me know what you did. Thanks!    — caneville (posted on May 16, 2005)

May 16, 2005
With a self-funded plan, the employer pays the bills anyway, and just uses the insurance company to handle the paperwork. The procedure is, you request authorization; if you are denied, you follow through on all internal appeals with the insurance company (if you have to -- ask HR); if you remain denied, you request that the employer agree to cover it despite the insurance company's denial -- because they CAN. It's ultimately up to them. So they don't "tell" the insurance company to pay or approve, they approve and/or agree to pay. At that point, the insurance company is, I believe, out of the loop, unless there are prenegotiated more favorable rates if it goes through the insurance company, in which case it's up to the employer to override the insurance company's denial in order to get the preferred rates.
   — [Deactivated Member]