Comment by mondocat

If you're part of a self funded plan, at least is some states, there is no external oversight over what they do or don't approve. There is an appeals process, but after exhausting it (where in our case it was the same reviewer in all three stages of the appeal - actually four, because they applied the wrong standard of care one of the times so we got to do it over) there is no legal recourse if they choose not to pay, whatever their rationale. My advice here, is if they tell you they can only authorize treatment once you've begun, that is not true, and if the plan is self-funded, they have very little incentive to do so, and ultimately you have no recourse if they don't.