[ESL]

John

I went thru an appeals process to my company's benefits commitee and was successful....the reason that you had issues with your "insurance provider" (basicall the 3rd party administrator for your company plan) was they keep the gate for your company plan. If the company says let someone thru, they will without a thought, but they are not allowed to let someone thru outside of the plan rules established without the ok from the company benefits committee....ever. Present to your company.....now you can use an economic argument because to them, it will be about money. If you have been with your firm a long time (thus suggesting you probably will be there long into the future) this helps you case (because if you are there another 10 years, you back problem is their economic problem).......email me if you want to talk offline.

Regarding the mention of the Aetna link, remember self insured plans are very different that fully insured plans.....appeals need to be handled very very differently depending on which bucket you are in......the Aetna stuff regards fully insured plans so would not apply complete to you John.