Just wanted to say I'm so mad I'm shaking

These plan administrators will get theirs on the day of reckoning.

NOW I can submit for external review.

Self insured plans are a joke.

AMEN!!

We have a self insured plan that we provide to our team. It is very generous and planned carefully so that we do not exclude things which many don't have covered through group coverage like fertility treatments and WLS. Your self insured plan might be a problem, but not all are. Some employers use it as a way to entice a high quality team...and as such it's high quality insurance.

Fertility treatments are covers as is WLS. But the requirements are so hard for a majority to qualify. They offer a lot of coverage, and my $4400 meds are covered. And i am so thankful for that. But the plan is putting up roadblock and just testing my resolve to get this surgery.

I'm sure your employees have moments of frustration with your perfect plan. My company is trying to please about 18,000 employees. And they are trying to help. But the plan administrator is using different information to deny each time.

So THAT is why I am pissed. And THAT is why I say it's a scam. I have even read about how self funded plan administrators use lowest weights and find the smallest reason to deny. So I think I have a right to vent, and if people don't like what I say, don't respond.

Of course you can vent, but if you post on a public forum that self insured plans are a joke, expect that those of us who put these plans together might take offense to that and offer up a different side of the story.

We personally have issues with the coverage or the administration on occasion, probably more than many of our staff given we've had some major challenges medically. We have used some experimental treatments or new treatments and even if you're the boss you have to work within the rules. But we use those challenges and any we are told of from staff as our guide for the program the next cycle so that we can meet needs we might not have perceived.

Our fertility coverage is based on what WE experienced on a personal level. Over a hundred thousand in costs. We also looked at donor eggs, something not typically covered by many programs. We traveled the country to cure our son, and in the process we spent nearly two million dollars trying to find out what was wrong with him. That took us down the road of "Fail to thrive with unknown cause" which is a bear for insurance coverage as it does not fit in any of the typical boxes. That was a great learning process for us again when working on our plan.

Vent all you want, but know that YOUR self insured plan is not the same as ours. We offer it because it offers more than we would get with a group coverage program through the administrator. We care if our staff are given the run around as you feel you are. Does your employer? Do they want to hear your story? Have you shared it with them? I know I'd want to hear it so I could make changes if they are necessary.

As to WLS...mine was not covered. I was below the bmi rate in our plan so I didn't even try for coverage. I would be sure to fight tooth and nail for someone who needed the surgery to have it....but I also feel quite fine that it isn't covered for low bmi with no comorbidities. Again, my experience talking. I wouldn't want to see anyone we know and love go through what I did! But people who need the surgery should have it.

Go talk with the person at your company who handles the insurance or if you aren't in contact with the owner, send them an email. If they are decent they would want to know what you are dealing with. I would.

This is a large LARGE company operating in 7 states. There are three operating companies working under 1 service company. We have the board of directors. We have opco presidents. CEO, CFO, directors, managing directors, and every level of management you can imagine. I am working with the vendor manager in the benifits department. They can not allow an exception because of the fiduciary process. The plan administrator told them what to do and we did what they said. Then it was denied. We followed what they said for appeal. That was denied. We sent what we were told would be the external appeal. It was another internal appeal. And that was denied. First appeal noted some comorbidities but not all. Used some weights, but not all. Next appeal they noted other comorbidities, but again not all. Used different weights, but again not all.

This is a joke. Again if people take offense to personal feelings, then why not just move on and let it be? My statement was directed at NO ONE. But people still have to pick fights.

SMH. Starting to see why so many people have left this forum. Can't state their frustrations without someone getting offended.

Public forum blah blah blah.

Self funded sucks for the little guy. Get over it.

I was attempting to share that your current situation isn't what everyone goes through and offering a suggestion for the next step. Our company is also a "large" company with all the messy levels of management If you're concerned, and it sounds like you are, go up the food chain. People do care, even in a large company. I'm sorry you are in this predicament.

ay yi yi... can we agree to diasagree.. fertility and wls??? yes this is a place to vent.. so vent on!!!!

ay yi yi... can we agree to diasagree.. fertility and wls??? yes this is a place to vent.. so vent on!!!!

LOL and odd mix...I got fat having fertility treatments heh heh It's shocking how little insurance covers! Wanna talk adoption coverage now? or boob lifts might be more appropriate

I was attempting to share that your current situation isn't what everyone goes through and offering a suggestion for the next step. Our company is also a "large" company with all the messy levels of management If you're concerned' date=' and it sounds like you are, go up the food chain. People do care, even in a large company. I'm sorry you are in this predicament.[/quote']

don't leave this is an awesome site...

This is a large LARGE company operating in 7 states. There are three operating companies working under 1 service company. We have the board of directors. We have opco presidents. CEO' date=' CFO, directors, managing directors, and every level of management you can imagine. I am working with the vendor manager in the benifits department. They can not allow an exception because of the fiduciary process. The plan administrator told them what to do and we did what they said. Then it was denied. We followed what they said for appeal. That was denied. We sent what we were told would be the external appeal. It was another internal appeal. And that was denied. First appeal noted some comorbidities but not all. Used some weights, but not all. Next appeal they noted other comorbidities, but again not all. Used different weights, but again not all.

This is a joke. Again if people take offense to personal feelings, then why not just move on and let it be? My statement was directed at NO ONE. But people still have to pick fights.

SMH. Starting to see why so many people have left this forum. Can't state their frustrations without someone getting offended.

Public forum blah blah blah.

Self funded sucks for the little guy. Get over it.[/quote']

don't leave this is an awesome site...