I beleive you are correct. Fedex self insures but anthem administers. I guess my question is have they denied any coverage or just suggested you dont need it?

 

No issues here. I just had surgery 8 weeks ago, I picked the doctor and hospital, no questions asked. Total cost was over $45K - $50 out of pocket plus copays for 2 prescriptions.

My only gripe is having to complete a form each year asking if I have any other insurance.

 

In my experience, they have always taken a dim view with respect to physical therapy.

 

5 wks, 2-3x/wk after my shoulder surgery 18 months ago, no issues.

 

Yeah, but you're special.

 

Mmmm similiar issues over our side of the pond.

 

We also have received a similar PT ruling, denying all claims after the first 20 for the calendar year based on "lack of medical necessity" because no further range of motion improvement is evident. However, like you, the PT scrip is written for pain relief to allow normal activity. If you read Anthem's policy on PT, it is divided into two sections depending on whether the PT is "rehabilitative" or "habilitative". Pain relief to allow normal daily activities (IADLs) is addressed under the latter and is clearly covered. However, Anthem apparently routinely cites only the rehabilitative criteria. Our appeal package is in the works.

Separately, we also had a snafu this year with their annual "Do you have other insurance?" drill. In the past, we filled out the form and got it back under their deadline, and all was well. This year (2014) they simply started denying claims and THEN sent us the annual form! I read them the riot act over the phone and they promptly reprocessed and approved the 6 claims they had summarily denied, but not before our reputation with our doctors were sullied.

 

Yes. Someone is clearly trying to cull some low hanging fruit. They just denied a medication my wife has been taking (successfully) for 6 + years. They cut the dose in half. Compared to some other medications she takes, it isn't that expensive, but there must have been some metric they found that said they could get away with cutting the dose. Which means I pick up the cost. They state that the "plan" will only cover a certain dose - what "you and your doctor" decide "is up to you" (i.e., you F-ing pay, not us).

I've been through this several times with them. Scum.