Oh.. hey, almost forgot--
If your plan falls under "self insured" ERISA says that "the company must run the plan for the sole benefit of its employees". Its been explained to me that ERISA makes your insurance an extension of your company, the company is legally bound to advocate for you.
Also, ERISA provides protections around explaining benefits. Insurers are bound to explain how to access benefits, including getting a prior auth executed. Stay tuned on the prior auth thing, I have something in appeal.
I had prior auths fail, hitched up my big girl panties, and made a lot of calls to figure it out. So I can't explain it like a lawyer, but think I am pretty close.
~Jenn