Ins. wording help- do I fight this???

mom24girls
on 8/1/07 4:18 am - Essex, MD
Ok So i called the ins company and was told that anything related to  weight loss was completely excluded. So I got on here this am and did some reading of previous posts. I decided to ride up and pick up a written policy. So as I look at it  this is what it says... Section C What isn't covered under the medical plan. The medical plan described above covers a wide range of services. However, benefits are limited in some cases. On the following pages, you will find some (not all) of the benefit limitations that apply to all Medical Plan benefits and others that apply to only certain benefits. Take the time to read this section carefully and contact the fund office for more information if you have questions. (there are 2 pages of limitations- but below is the ONLY thing that relates to weight the wording is exact) General Limitations: * Behavior modification techniques (i.e. smoking cessation or weight loss services)  I also see on here that they are a self-insured plan which means that they are exempt from marylands law that requires them to cover the surgery, instead they are governed by ERISA. Any help would be greatly appriciated. 

Dianne

marcoislandmom
on 8/1/07 8:50 am - Naples, FL
If this is a self-insured program, it means that your employer is footing the bill. Speak with HR about the potential of having this approved. Ultimately, although they pay an administrator to administrate the program, your company will pay the cost and can make the decision.
 

Marco Island Mom
gary viscio
on 8/2/07 7:41 am - Oceanside, NY
I agree talk with HR.   I have an ERISA case I am suing on behalf of a patient in Maryland for almost the same reason.  Their HR wouldn't help, but yours might
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
mom24girls
on 8/2/07 8:43 am - Essex, MD
His work does not have an HR- It is a union hall. The board of trustees make the decisions, and are you ready for this, they only meet 4 times a year. SIGHHHH  SO I "think" what I understand that I have to do is write a full presentation to the board of trustee. They have to recieve it 2 weeks before the next meeting to make the agenda, or it waits till the next time. Then they will make the final decision.  Sounds fun.

Dianne

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