Dan Pind, Published March 14 2010
Sanford no help for sonMeritCare’s change from Blue Cross Blue Shield of North Dakota to the Sanford Health Plan has become a burden for my family. My son has special needs and requires therapy-based services.
Last year, MeritCare’s employees had BCBSND. Their policy stated that there was a maximum benefit allowance of 90 visits per member per benefit period. At the request of my son’s doctors, BCBSND accepted a request for additional therapy services. This year, however, the requests for additional therapeutic services have been denied by Sanford.
The employees of MeritCare were told that their benefits would not change when they switched providers. However, Sanford Health refuses to provide my son with additional therapy services as BCBSND did even though Sanford states on their Web site, “Benefits are subject to a maximum benefit allowance of 90 visits per member per benefit period. Additional benefits may be allowed when medically appropriated and necessary.” This statement is a lie.
A leading doctor at the Mayo Clinic in Rochester told my wife and I that my son is the worst case that she had ever seen. Any doctor who has ever seen my son agrees that he needs as much therapy as possible. Sanford Health is aware of this fact but refuses to adhere to the “medically appropriated and necessary” clause in their policy.
I can only speculate that MeritCare chose Sanford over BCBSND due to lower insurance premiums. I presume that Sanford is able to offer lower premiums by enacting a policy of denying their customers additional services even though the services are greatly needed.
I sincerely hope that MeritCare reviews its contract with Sanford Health this year and chooses BCBSND next year. My son needs therapy, and Sanford Health has made it clear that he will not receive the therapy.