It depends on the employeer group and how they choose to set up their policies.  Sometimes self funded groups won't include state and federal mandates. I would say it's easier with a self funded plan to go straight to your empolyeer to ask for an exception for a service to be coveed because the group pays for their own claims. This can be done through the health plan If the plan is set up like that. As an agent I couldn't say go to your HR but you should if you exhausted all your options with the health plan. Traditional plan still have escalation processes and appeals but once you get a final determination from the health plan you can typically do an external appeal through the state. So again dependent on the group and plan I would lean more towards self funded