Health insurance denial for treatment and “self-funded” plan rules?
Well, it’s going to sound like a lame answer, but all of these self-funded plans have customized and different rules, there are no concrete answers because each plan is different. There was probably plenty of fine print for you to read through when you signed up. You’re probably in need of a lawyer if you want to decipher all of your rights in the plan. You need first to get a copy of the plan agreement that you signed, and read over it yourself, but the lawyers will probably need to hash out the finer detail and decide if you have a chance of getting your treatment. Just a note for you to consider…..A self funded plan is NOT managed by the employer. There are laws against just that. A third party, just like you’re saying, is in charge of deciding what all gets covered (such as Aetna, or Healthnet, or whoever), but it’s most definitely not the employer making the decisions. Also, the reason why there are these self-funded plans to begin with is because the price of health insurance h
