Question:
Does anyone have experience in appealing with a self-funded plan?

My plastic surgeon's first request for predetermination was denied by UHC PPO. I recently sent in an appeal. However, I also recently learned that the plan is self-funded. I now know that complaining to the state insurance commissioner does no good when the plan is self-funded. You have to address your complaints to the federal government, specifically the Department of Labor at www.dol.gov. Anywho, I was wondering if anyone has tips on dealing with UHC PPO, self-funded, etc.? Many thanks, Anna    — Anna L. (posted on June 16, 2003)

June 16, 2003
You might also be able to appeal to your employer, since it's a self-funded plan. Call your HR department to find out if you can appeal to them and if you can, what the process requires.
   — garw

June 16, 2003
Thanks Gar, I did call hubby's employer H.R. department/Benefits Coordinator on Friday. She says it has to go through appeal at UHC then they present it to the employer.
   — Anna L.

June 16, 2003
The Company I work for has a self-funded plan also. Because a self funded plan means the Company is paying for everything out of their pockets they will do everything possible to keep costs controlled. In their thinking, excluding WLS saves them money, although WE know in the long run it is more cost effective to let a MO person have the WLS and avoid a lifetime of co-morbidities and all the expense involved in treating them. As far as my Company is concerned I KNOW that they will tell you to appeal - but THEY know you are just going through the motions - they will NEVER approve it! Thankfully, my husband works for a hospital - and they cover it! Good luck in your journey.
   — Susan B.

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