Question:
Employers Self funded plan....What does that mean exactly?

I was reading my plan from great west, does that mean i have to fight with the employer over the exclusion policy?    — witchywoman (posted on April 27, 2006)

April 27, 2006
yes you will have to 'fight' your employer. Self funded, whether they administer the plan themselves or have a third party like aetna do it; if you have a 'third' party you have to appeal thru them first; then the final appeal goes to your company - they can 'change' their mind and pay it. You could also go directly to your RISK management and see about lobbying to get it changed - since it was 'them' that put it there in the first place.
   — star .

April 27, 2006
Kimberly, my employer is also self-funded, but I found them to be very cooperative regarding the surgery. I discussed my concerns for coverage with my boss and she in turn relayed them to one of our VPs. When it came time to get approval it only took about a week. The good thing about self funded insurance is that the employer has the ability to tell the carrier they will pay for a particular service. I know discussing personal issues with co-workers, bosses, HR is not always the best thing to do, but maybe there is someone you trust within your organization, in a power position that may be able to assist you to get the surgery covered. Good Luck!
   — pumpkelina

April 27, 2006
Both posters are correct and I would like to add to Christines. Most self funded policies are administered through a third party and would need to initially be appealed through them. However, I have paid a few claims where the service was not covered and the company asked us to override the denial and pay the claim. Good luck!
   — RebeccaP

April 28, 2006
Thank you all so much for your responses, I have been trying for six years to get this surgery and something always gets in the way but I will fight till theres nothing left!!!
   — witchywoman

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