If your wife works for a larger university, chances are the university is actually self insured. In that case, the insurance company is acting as agent to handle the paperwork and insure a "separation" between the university and the insurance decision. If that is true, the University actually decided on the restrictions and limitations in advance- they are just blaming the "big, bad" insurance company.

The reality is that most large employers/companies/governments actually operate in this fashion. The state of NY certainly does (if she works in the SUNY system). Fifty-five percent of covered US workers were enrolled in self-insured plans for health care last year. Companies do not necessarily advertise it, as it is convenient and cheaper to take a hands off approach. In instances where the insurance company is acting as agent for a self-insured (or self-funded) company, they typically bill the company for the aggregate amount of claims paid plus a percentage (2% to 5%) for processing. In these instances they would actually hurt their profits by denying claims ......

Last edited by Stormy; 12/17/09 12:26 AM.