Insurance Policy Changes

I was just wondering if anybody had their insurance company changed the requirements.

Mine, (BCBS of MN) first told me I had to have 6 monthly visits to my Primary Doc, as part of a diet plan. Then, on Feb. 15th they changed there policy to 6 "Consecutive" months. Well, April would of been my 6 months, but I missed an appointment in Feb. so now i'm starting over again with only one month in (March).

Anyone have any suggestions??

Dave

I hope you don't have the problems I've had with BCBS.  I have a PPO policy thru BCBS of Illinois.  I am having an extremely difficult time with them and have been denied twice, so far.  Their reason for the first denial was "not compliant with diet".  In other words I consumed too many calories vs. what my nutritionist designated.  Hello?, I have a full sized stomach, hunger and portion control issues, etc.  I appealed based on their criteria of their Medical Policy (which states 6-month diet must be ATTEMPTED).  They conceded, BUT they came up with 3 more excuses to deny me: 

1)  5-year weight history incomplete
2)  No psychological evaluation, and
3)  They ADDED a requirement for a TSH level. 

The first item I'm working on to get as I have one doctor who is no longer with the clinic I used only once because it was an emergent situation; the clinic has changed ownership if you will several times and they seem to have difficulty in finding my find although it's in their computer.  The second item was submitted to BCBS as part of my original submission so don't know what their deal is there and the last item is a new requirement that isn't part of their Medical Policy that describes the criteria although I actually have had that done and it was a part of the original submission of medical records as well. 

I'm telling you all this because you need to ask them for a copy of, or direction to their website, that shows their Medical Policy.  This is the only document they and you can go by.  For my particular plan it does not have to be 6 consecutive months as the Medical Policy does not state this.  So just be sure yours does otherwise they cannot make you start over.  If you have to go the appeals route, the Medical Policy criteria is what you will have to prove you followed and use as reference in your argument/request for review and approval.  On my 2nd denial letter they do state that if I can provide these 3 items they will re-open my appeal case.  They also state what they are required to do in case of lost appeal which is you can file formal complaint with the governing state's Insurance Commission.  Hopefully yours won't go that far though.  Just check out your Medical Policy to make sure this is truly required under your plan.  They have so many different plans there is no doubt their customer service people are confused.  I've been told different things throughout my whole 6-month medically supervised plan about the other requirements each time I've called and talked to someone there so again, it's critical you get a copy of the Medical Policy for your plan.  That is what they have to go by irregardless of what any customer service rep may tell you on the phone.  Good luck to you.  It's a hard, challenging road for some of us to get approval.  Stay focused and firm in your resolve to get what you deserve to help make a healthier life for yourself.