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Insurance denying rehab stay need advice!
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Insurance denying rehab stay need advice!

Hello everyone, just wanted to know if anyone has had any experience with dealing with insurance companies.
My son has been in rehab now for 9 days. For the first 5 days in detox he was fighting to come home. Threatening to walk.

I told him to keep walking.

He is now 4 days into his "step down" treatment. As of 2 days ago, he stopped the phone calls to me begging to come pick him up.

Today I visited him. He is so tired looking, Says he has only REALLY slept one night out of the 9 nights. Always aware that he is not completely sleeping.
We found out today that the insurance said he will have to leave on Monday. He broke down and started tearing up pretty bad.
He now knows he needs to stay and that he is not strong enough to leave. He asked me to call and fight it. He does not want to leave yet.

His insurance handbook says he is covered 100% for 30 days. counselor has made his plea and recommendation to the insurance and they said basically "tough sh*t" He is out in 12.
I am beyond furious.
Anyone have any suggestions. My son is 20 and is going to have to appeal their decision. I called the insurance commisioner in our area but missed them for the day.

Any other ideas?
thanks !!!
mmj
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8 Comments Post a Comment
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243614_tn?1266201137
I don't know how they can do that, if the manual says he is covered for 30 days!  What is wrong with those people??  Keep fighting.  Call them tomorrow and talk to a supervisor or someone higher up.  I wish i could be of more help, but i don't know what else to do.  Calling the insurance commisioner sounds like a good idea also.  Sounds like your son is on his way to making it, if they will let him stay!  I hope for the best for he and you.  Good wishes. tJack
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396099_tn?1216258586
The exact same thing happened to a family member and what we did was call the insurance comissioners office in our state and we told our company that we had done so and that we intended to pursue it till we got satisfaction.  Like magic they saw the light.  It's the policy of a lot of companies to deny deny deny.  The figure a certain percentage will just go away.  Make sure they know that you won't go away and you will go after them in every possible way.  they'll decide that it's cheaper to jus give in than to fight.

Good Luck!
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429432_tn?1343597790
Right on! They tried to kick my husband out of the hospital when he was still gettin iv antibiotics, I didnt budge or pay, and everything worked out. Those insurance jerks are so intimidating!!
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Avatar_f_tn
Keep working through the appeal process. Although the policy says 100% coverage for 30 days - that is based on "medical necessity", which they define to meet THEIR set of criteria. That's the loophole. Find out what their specific criteria is - maybe you can fight it that way as well. But hopefully the appeal process may work in your favor. 30 day inpatient care is becoming rarer and rarer these days - the medical community is very frustrated over this, too.

In any event, 5 days, 10 days, 30 days.....it's not a cure, it is the beginning of a process.....it would still be recommended that he go to a recovery home after that - considered the next level of care. It is a sober environment with support but not a hospital. They have structure (good thing) and they help the person ease into getting a job, school, whatever their goals may be. The cost for this is not paid by insurance - it is not a medical facility - however, the cost is the same as if he were sharing a place with some friends, and varies the same way that would. Some get subsidized by various county, city, state, fed programs, many variables.

Hang in there! Make your calls and be the squeaky wheel - it may pay off. But also start doing a little research for the next phase of his treatment.

Best of luck to you. It's tough watching kids do this to themselves. Very difficult.
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Avatar_f_tn
We are going through the exact same thing...The insurance booklet says they pay 100%, and ended up not paying 1 cent because of some clause.......
We had to pay on or own and has cost thousands of dollars....I didn't know i could appeal this....Great info.
thanks guys
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Avatar_f_tn
TJack
I am going to fight it starting tomorrow at 7:59am. I will not stop. My son will need to call and appeal, because he is over 18. I want to have an emergency meeting at the rehab to be there when he calls. He is not prepared or experienced enough to deal with these a- holes.
The rehab wants him to stay and has made this recommendation to the insurance co.

DUCK and CATMAGNET: I think you are right... Another woman at the rehab said they denied her daughters stay. I told her to call me and we would talk and try to figure this out. I never heard from her. The "percentage" that just 'goes away'
NOT ME man! I am going to fight! I worked for HMO years ago (years) and their motto was "all claims are initially denied, unless the patient causes a stink, then they would review it" I HEARD THEM LAUGHING ABOUT IT!!

Two parents wrote to appeal their denial because their son had shot himself in the head and was rushed to the ER. They denied it until the letter came in from the parents asking that their claim be re-evaluated and that their had died. The claims dept. never even looked at the reason he was brought in.!!

r2h:  that "medical nessecity" is a big part of this. I have the handbook and there is a chapter on 'criteria" you are right. I will study that tonight!
loophole my butt!  My son is just starting "inpatient" he has only been there 4 days. the first 5 days were detox. He slept alot of the time. and was disoriented.

Thanks for you advice! I cant wait to get this started in the morning.
When his 30 days is over (and I will get 30 days for him) I KNOW where their office IS!!
he will then go to my fathers for 30 days. working with him everyday. we have counseling set up and NA meetings as well. 3 -4 meetings a week. I will work on his sponsor over the next 2 weeks. We have about 10 people on his as* when he gets out. He will sign a contract with us and will continue intense "attention to detail" therapy from us all! We are not going to let him fail

He wants this SOO bad...He can not turn back now.
I am ontop the ALANON thing too so I know I can not 'save' him..... but damn I am not letting him go down without a fight!

mmj



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Avatar_f_tn
GREAT ATTITUDE!!!  I love it......Good luck
r2r
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Avatar_m_tn
I am really pulling for you (and your son) in this fight.  I think that the insurance companies are evil organizations and are one of the big problems in this country.

It sounds like you have a good plan for your son and the tenacity to deal with those bastards.  Your son is so young and has so much to look forward to.  Once he gets thru this and then learns how to stay clean and enjoy life he can look back and see how far he has come.  Anyway I'm praying for y'all and will follow your posts
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