insurance denials

MY SON IS BIPOLAR WITH ALCOHOL AND DRUG ADDITION.  FOR YEARS STARTING IN HIGH SCHOOL HE WAS IN TROUBLE AND HOSPITILIZED TWICE, IN SHORT HE WAS LIVING ON THE STREET FOR A FEW WEEKS AND USING. HE WAS NOT ALLOWED BACK IN THE HOUSE . HE ENDED UP IN JAILAND ASSAULTED A POLICE OFFICER. FROM JAIL HE SENT TO FATHER MARTIN ASHLEY REHAB CENTER FOR DUAL DIAGNOSED PROBLEMS. THEN FROM THERE, TO SEVERAL REHABS AND HALF-WAY HOUSES IN FLORIDA. THIS SAVED HIS LIFE BUT NOT MY POCKETBOOK.

ALMOST $20,000 LATER AND A YEAR OF APPEALS TO NJ HORIZON BLUE CROSS BLUE SHIELD, I DID NOT RECIEVE A CENT.  THREE APPEALS AND A FINA LEFT ME WITH THE REASON "HE CAME FROM A SUPPORTIVE FAMILY AND IT WAS NOT NECCESSARY TO SEND HIM AWAY" HE COULD HAVE BEEN AN OUTPATIENT.  I HAVE BEEN PAYING INTO THIS INSURANCE FOR 20 YEARS. I FEEL BECAUSE I WAS ABLE TO PAY THE REHAB CENTER UP FRONT, THEY DENIED IT.  WHAT PARENT ISN'T SUPPORTIVE?  MY POCKETBOOK (A CHARGE CARD!) SUPPORTED THE PAYMENT SO IT WAS DENIED.  HAS ANYONE HAD RECOURSE ON PROBLEMS LIKE THIS? OH, AND THEY DID PAY FOR FLORIDA REHAB AFTER FATHER MARTIN'S-THE REHAB SUBMITTED IT!!  THERE ARE VERY FEW PLACES THAT TREAT DUAL DIAGNOSIS AND FATHER MARTINS IS ATHE BEST- IT WAS WORTH IT,BUT HORIZON BLUE CROSS GOT AWAY WITH $20,000!!
KATHY

[ILADVOCATE]

First of all have him apply for Medicaid. At least in New York state there is a parental refusal form where if a parent cannot support their child's medical benefits the child can be covered. I don't know which state you are in but perhaps they have a similar program. Secondly, the mental health parity law was signed and will go into effect on January 2010 so they can't deny coverage for mental health and substance abuse treatment for any insurance. However, as for the issue of your son having an income, have him apply for SSI. He does have to be free of any issue as regards substance abuse to qualify so if he goes to a rehab. program and they can prove he is no longer using drugs, he can then qualify as regards his psychiatric disability. You can get help with benefits and advocacy at your local independent living center. There's one in every county of the United States. Here's a link to all of them:
http://www.virtualcil.net/cils/

[RJ233]

Normally, each state has an Insurance Commission. Contact them and let them know about the denial and why you think it should cover the medical costs. They will investigate. You are right about paying up front. You have paid it and they don't want to part with the money and give it back to you. They drag things on to discourge you. Make sure you have all your records. That will help you as visible proof to the Insurance Commission. Send them copies of what you think will help your case. NEVER LET ANYONE HAVE YOUR ORIGIONALS. Hope this helps. RJ