BCBS denied my request for a case manager!!!

YankeeRose
on 6/15/05 2:16 am - Meadville, PA
I called BCBS this morning to request a case manager be assigned to me to help me. My policy states: "Under the case management program, the plan will identify members w/potentially complicated medical needs, chronic illness and/or catastrophic illnesses or injuries that may be suited for alternative treatment plans. After evaluation of the member's condition, the plan may, at it's sole discretion, determine that alternative treatment is MEDICALLY NECESSARY and APPROPRIATE. In that event, notwithstanding any provision of this EOC to the contrary, the plan may elect to offer alternative benefits for services NOT OTHERWISE SPECIFIED AS COVERED SERVICES." Well, BCBS said they could not assign me a case manager because obesity is not a covered benefit in my plan (exclusion)!!! Does that make any sense to y'all? I am so frustrated with BCBS. I thought it was my right to have a case manager assigned to me? Anyone else have this happen to them? Tammy
Roberta A.
on 6/21/05 5:33 am - Marietta, GA
Can you appeal that decision?
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