Just as the title says, can your employer step in on this and stop a treatment?

small example, I've seen stomach staple be turned down, shots for a shoulder injury get turned down.

They all was determined non-medical is the reason given to why they was turned down.

Nope, doesn't matter if it is work comp or private insurance with the small exception of a casino (Indian gaming rules differ). However, comp or private insurances often times deny a certain procedure initially until other certain more conservative options are exhausted. Examples would be needing to lose 20 lbs prior to stapling being approved (need to show some personal commitment and self-control prior to them paying thousands for a procedure that may or may not work) or denying an injection for a shoulder when research has shown that an injection for a given diagnosis is not effective. Usually there are just hoops to jump through, but your employer should have no say whatsoever in your medical care.

interesting, i ask because these employees are not favorites in the employers eyes, so its just kinda funny that these individuals seem to have medical issues denied.

One employee had a breast reduction and the insurance covered it, so the staple stomach employee was wondering why it was ok for a breast reduction?

Well I was just checking, see if anyone else may know the answer, cause that would tick me off if your employer can have things denied,  thanks

Every insurance policy has exclusions and limitations that apply to the coverage.

For example, stomach stapling is excluded in almost all group health contracts. Employer can buy back the coverage for a very high premium, like $15 a month or higher per person, which is not economically feasible.

If the procedure is included as a benefit you are entitled to it.

Remember, group health insurance covers medically necessary treatments.  If the procedure is not medically necessary it is not covered.

So when you go to the provider tell him/her that what ever it is hurts and you need it repaired so the provider can check the correct code on their services sheet which is sent to the insurance company. 

Fishing Buds, stomach stapling is very dangerous and it has many complications.

Sometimes the procedure will be covered but the prescription drugs are not covered.

I have had two clients who have had an employee pass away from stomach stapling complications.  :'(

interesting, i ask because these employees are not favorites in the employers eyes, so its just kinda funny that these individuals seem to have medical issues denied.

One employee had a breast reduction and the insurance covered it, so the staple stomach employee was wondering why it was ok for a breast reduction?

Well I was just checking, see if anyone else may know the answer, cause that would tick me off if your employer can have things denied, thanks

Breast reduction surgery is often done to alleviate chronic back problems, not for cosmetic reasons. That's why it's covered and stomach stapling is not. Diet and exercise will help people lose weight. As far as I know, there's no exercise that will drastically reduce a woman's breast size.

Having done a number of IT projects involving medicaid/Medicare and private insurance company claims systems, I can tell you the approval/denial rules for these systems are VERY VERY complex and we constantly refined them. They are made on a number of reasons. One of course is price. If one procedure costs a pile of cash and their is a cheaper alternative, then they will deny it. Stomach stapling they would say...go on a diet. Costs us nothing then.

The overall goals of these rules are to expend the least amount of money possible while trying to keeping policyholders at least moderately happy. The sick, sad truth is they are a business like any other and cannot spend more than they bring in without going out of business. The difference is, their decisions can kill people or significantly reduce their lifespans. 

It is a really twisted business but it is one that we need.

Having done a number of IT projects involving medicaid/Medicare and private insurance company claims systems, I can tell you the approval/denial rules for these systems are VERY VERY complex and we constantly refined them. They are made on a number of reasons. One of course is price. If one procedure costs a pile of cash and their is a cheaper alternative, then they will deny it. Stomach stapling they would say...go on a diet. Costs us nothing then.

The overall goals of these rules are to expend the least amount of money possible while trying to keeping policyholders at least moderately happy. The sick, sad truth is they are a business like any other and cannot spend more than they bring in without going out of business. The difference is, their decisions can kill people or significantly reduce their lifespans.

It is a really twisted business but it is one that we need.

and people point to death panels when discussing government health insurance.

Those panels already exist within the insurance companies already.