Question about employer's partially self-funded insurance plan

[Guest guest]

Hi,

I know this type of insurance (employer's self-funded plan) has been discussed

on

here before and I am looking for some guidance from those who may have this type

of plan. I know that at the end of all appeals we do not have the right to ask

for a

review with the state insurance board as they do not get involved with this type

of

private, self-funded plan. Our plan document does lay out the appeals process

with

the claims administrator (the insurance company doing the administration of the

plan) but it also mentions that the plan administrator (the employer) has the

complete

discretion and authority to determine the benefits we are entitled to receive.

So, it seems that the employer can override any denial by the insurance company.

Is

this the case? If so , at what point do you ask the employer to do this? Is it

after all

appeals with the insurance company or at some earlier time? If anyone has

knowledge

of, or experience with this type of situation I could certainly use some

guidance.

Thanks,

Mark ('s dad)