Question about my insurance disability claim explaination & THANKS!!

[mompain]

First of al, I want to thank all of you who have been thinking of me and offering encouragement when my insurance company refused to pay for my Provigil.  They are still refusing to pay without a sleep study, (I have an appointment for this in early August), but my WONDERFUL, CARING doctor searched high and low and came up with enough samples for me to have enough for the next month.  Now that is the kind of doctor that I have said many prayers in search of.  This pain institute that I am going to now takes the comprehensive approach and cares for the whole me.  I love them and how they care and truly want to help patients work through their pain and problems. 

Now to my disability claim question.  I recently received an answer to my long term disability insurance claim and they said that they were going to have to do a "Behaviorial Medical Intervention" in order to reach a conclusion about whether or not they could pay my claim of disability.  My Sjogren's doctor has sent them all of my medical files and a letter stating that I am not able to work because of numerous health problems.  What is going on with this "BMI" thing?  I have never heard of it and neither had my doctor when I called her.  I don't mind the insurance company doing whatever they need to do because everything I have sent and stated is true concerning my disability but I feel as if they are just trying every way they can to get out of paying my claim. I have had this insurance for over 15 years and have only used it 3 times, so I am not one to take advantage and overuse.  Can anyone offer a thought on this deal?  I can't quite figure out what is going on. 

By the way, I did contact them today and told them about my pain institute doctors that I was not seeing when I actually stopped working due to disability but started seeing very soon afterward.  I told them I would like for them to get those records if they had any problems backing up anything that I or my doctor has sent them.  I thought maybe they thought this was only these few doctors sticking together and that is why they did not approve my claim. 

Any advice???  I would truly appreciate it.

[Linda196]

Mompain, what a great gesture on your doctor's part...going above and beyond to round up enough Provigil samples definitely earns the "wonderful caring" label.

You insurance question is not uncommon. A Behavioural Modification Intervention provides concrete information regarding an employee's abilities and potential risks in their job. Its basically a fancy name for a psychiatric evaluation that is supposed to focus on the client and their job, and is a regular part of most screening policies.

I think it was a good idea to give them the additional information about the new doctors, in fact many companies have a clause in their disability plans requiring that you let them know about any new health care providers.

Pretty much any insurance company's job is to avoid paying "unnecessary" claims, and they sure seem to do that part of their job very well. The official line is, "If we don't pay on every claim that comes through, you don't have to pay inflated premiums"....that might be true, but it seems we still pay plenty, and have to jump through hoops when we need the insurance. I've often wondered how much the cost of all this investigation adds to my premiums, but they don't seem to like that question!

[Pooh]

Good Morning Mompain,
I just wanted to wish you good luck with this situation.

I'm afraid I can't help you with anything pertaining to insurance.  All I have to do is see something with the words INSURANCE and my brain locks up.   I just hand it to my hubby and say "here you read this and tell me what I have to do, please".

Hang in there and I hope all of this turns in your favor.

Pooh