Has anyone successfully gotten a policy exception from an insurance company, for additional PT/OT/SLP visits? This would not be an appeal.

It is a Premera Plan in Washington state. The policy very clearly has a 14 visit combined cap and between the 3 disciplines, we’ve hit the cap already. I realize there is no reason to appeal the future denied claims, because the denial is valid. There is nothing to argue.

For this patient, a child with Down Syndrome, 14 visits isn’t nearly enough to make any progress.

Does anyone have any tips for how I can make this happen? I know policy exceptions are generally for Drugs and out of network services.