Hi, My family member has a PPO with a large insurance company in USA. She needs OT, ST and PT and is making remarkable progress in all 3 (neuro recovery). She's exhausted her benefits but has been approved for additional visits this year, which she has also exhausted. She applied for more visits this month with the nurse case manager team and the team has given us totally conflicting answers in the past week. The answers went from denied extra visits, to approved extra visits 7 days later (with a new auth number) to denied again only 24 hours later. What is going on? They told us the same medical director gave all 3 answers. Is the medical director really reviewing the clinicals?
Any shared experiences would be greatly, greatly appreciated.
And I've read some of the threads here where some nurse case managers who help their patients, feel under appreciated and get no thanks. That's such a shame. I am so sorry for anyone who treats you like that because any of you telephonic csae managers who are kind enough to help us patients and caretakers are truly ANGELS! You have no idea! So I thank you 1 gazillion times , on behalf of the people who never thanked you!