What is a Self-Funded Insurance Policy?
A Self-Funded Insurance Policy is the employer funds the plan and the health insurance simply administers the edicts/wishes of the employer. This also means that if you are in a self-funded plan, you do not have the option of appealing to the state level (refer below). Typically, some type of appeal process is in place. When I began my appeal, there were three levels: A written letter to the health insurance company requesting that my denial be overturned. A lot of supporting evidence accompanied this letter explaining the procedure and why it was a more viable option than major surgery, etc. The second level was a hearing with the health insurance company that included a doctor and registered nurse, both employed by the health insurance company, plus an ‘un-partial’ participant who is covered by the same health insurance company as I am. The third level was a letter to my parent company providing all of the background leading up to that level of the appeal. When my appeal was approved
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