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What is a Self Funded Insurance Plan?

It has taken three months, a call to the executive office at United Healthcare, escalation to a "Rapid Resolution Team" and I still have not been reimbursed for my medical expenses. They said it was a self funded plan. Does that mean that United Healthcare has to ask my company every time I submit a claim to get a reimbursement? Why is there such a delay with getting payment back. I never had this problem with Aetna. Thanks! Thank you. But here is where I get confused. Who is causing the delayed payment? United Healthcare?

Public Comments

1. a self funded plan sounds like a medical savings type plan where it has a high deductible of say around 5000 which you have to fund yourself then they pick up the rest. read your policy carefully to c what type of plan you have
2. A self funded plan provided through employment or an association plan means that there's no insurance company, HMO or other organization paying the premiums for the plan, it is funded by the employer. That same employer may assess a payroll deduction cost to you and fellow employees or may fund the entire cost as a part of doing business. It is commonly the case for large employers to turn over the administration of their plans to an Administrator who are there to perform administrative services. They are referred to as ASO's and are usually organizations who specialize in the administration of claims, more often than not, they are insurance carriers. Your plan documents should describe the steps which you need to take to resolve disputes, there's a set procedure required under ERISA. If the United Healthcare is not providing you with answers, you should speak to the Human Resources or Risk Management people in your company. Attempt to find out if there are others experiencing the same difficulties. At some point, it would be a good idea to begin documenting, in written form, everything that you are going through, names, dates, etc., and eventually prepare a letter to the President of your company. Don't show anger, let the President know why the Company should be questioning the quality of the ASO.
3. A self funded plan means that your company has bought additional benefits for their employees and they fund the money their self. United should be able to get your refund back to you without problems. Call and let them know that you will go to the cooperate office and to the insurance commissioner. That will make them move. Good Luck!!!!
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5. Self funded means United 'processes' claims, and uses money from your employer's bank account to actually 'pay' them. Your medical bills are paid by your employer. It depends on why the claims are unpaid... Is your company out of $? Probably not, its too early in the year. Are they questioning the service? Asking for medical necessity info? Are they just seemingly stuck in cyber space, claim Hades? What is the service for? Why isn't your doctor filing claims for you? Need more info to figure out who is at fault. Its probably a little of both. More often than not, mostly the insurance company's fault. If they're using 'self funded' as a shield it can refer to the amount of time its taking them to pay claims. (if it were not self funded, there would be a $ penalty.)