Insurance company denied us!!

Discussion in 'General Parenting' started by Jena, Sep 30, 2010.

  1. Jena

    Jena New Member

    i just got a freaking call from some bs person at hospital where difficult child is. last night they came into difficult child's room and announced ok we all won the fight she is approved!

    than today i get this call.difficult child is on the phone with-me right now freaking out becaues their now telling her that she has to eat every bit of dinner or she has to sit there alone.

    and now their telling me their doing an appeal tmrw. and c if they overturn it. if they donlt' i gotta discharge her tmrw.

  2. smallworld

    smallworld Moderator

    Eating disorders are often not covered by insurance companies -- I'm not really sure why. Perhaps if the hospital codes it differently? You may need to talk to someone in the admitting office.

    Deep breaths.
  3. Jena

    Jena New Member

    they lied to me last night and husband. i'm on hold right now. than their forcing difficult child to eat. wtf. their making her miss groups that she needs and forcing her to sit there for an hr and a half. i'm really losing it right now
  4. Jena

    Jena New Member

    small they cant' change the coding due to fact that they are specifically a eating disorder clinic within a hospital. i already spoke to head pyschiatrist. the insurance co. wound up lying to hospital last night. i will have to discharge if i cannot get them to approve it.

    ok there should be a bar in this place. i just called insurance company and advocacy group thru insurance company and told them if she dies it's on your hands. do you want that responsibility?? their bringing case to a supervisor and calling me back.
  5. smallworld

    smallworld Moderator

    What is the reason they denied the hospitalization?
  6. Andy

    Andy Active Member

    Forcing her to eat is not at all the impression I got when you described the program. I think you need to talk to administration about that issue. Although there may be a time that is required, I would think some of the educational classes/groups should be attended first.

    The program also needs to go over with you the eating process/requirements - how much food are they "making" her eat? It may just be a very minimum, much less than you envision? Don't ask difficult child, to her, she would be given a huge helping of everything when it may only be a bite of each food group? Ask to see for yourself the portions.

    You are being drawn into difficult child's emotions just like every parent would be. It is hard to keep things straight when she is screaming for you to fix things to her liking. Make sure it really is that horrid before reacting to swiftly or out of frustration.
  7. Farmwife

    Farmwife Member

    Tell the insurance that if they refuse her that perhaps they need to find a reasonable alternative because clearly she is in need of help and it seems that every viable option is turned down by either insurance or psychiatrists.

    I am not surprised she is upset about their program right now. Though it sounds a bit strange in a therapeutic sense it isn't so uncommon for an adult to make a kid sit awhile to think about being hungry/not eating before they let them run off to "play". I have done it with my difficult child a couple times when he was younger and it worked for him, though he had no eating disorder.

    It may not be some brutal force feeding issue as much as it is denying a reward activity with the group for her lack of compliance. Though it may seem harsh they may have to exhaust some basic tactics before meeting whatever their protocol is for the tube feeding. They have to document her behavior in their own records regardless of what your paperwork said just to cover their rears. If they are a specialty clinic with a good record one would think they have certain policies and procedures to follow before ramping up her care a notch.
  8. klmno

    klmno Active Member

    I don't know about the insurance stuff- the only thing I can think of is that it would have needed pre-authorization. Did you check on anything pertaining to this with your insurance company first?

    As far as making her eat, I'm wondering if they are taking this approach to see if they can see a reason behind it themselves. You know how profs are- it isn't enough for a parent to tell them "it's because of difficult child's anxiety" or phobia or whatever- especially when in-patient. They have to do an evaluation themselves. I'm just wondering because I'm trying to give them the benefit of the doubt that they have a reason for doing this and it isn't solely just thinking they can make her eat this way. Playing devil's advocate here- Jen, I definitely understand being concerned about it and wanting to discuss it with someone running the program there, but if they have a valid explanation I think you need to back off a little and let them do it. If this is tough for you, it's going tto be even tougher if someone physically forces a tube down her and makes her "eat" that way, I would think.

    ETA: I read over FW's response more carefully and just realized I was trying to say something similar to that. Sorry for being redundant.
  9. susiestar

    susiestar Roll With It

    Jena, do you have the info about forcing her to sit there until she eats from difficult child or from the staff? If the staff is doing this, they should be able to give you a reason WHY. It is a therapeutic place treating eating disorders, so they should be able to say why they are forcing her to sit there. It may be that difficult child is telling you stuff to upset you, or exaggerating what they are doing.

    BEFORE you get upset about what they are doing with difficult child, be sure you find out what is going on from the staff. It is VERY common for kids to tell parents that the hospital staff made them do something outrageous or awful, just so parents will get mad and take them out of the hospital. Wiz told us that one of the interns watched him shower and wouldn't let him out of the shower for an hour and a half. In reality he was showering with swim trunks on because he kept telling them he had washed when he hadn't. The man was a trained therapist, with an intern there so that nothing wrong was happening, and he was showing Wiz that he could NOT get away with getting the top of his hair wet and his toothbrush wet instead of actually showering and brushing his teeth. It took 4 hours for him to actually do all the steps in a shower. He went in, did 1 or 2, came out and dried off. Was told to go back in and do it all again, over and over until he did it all during the same shower. The next day it only took 2 hrs, and only 1 after that.

    As for insurance, that bites. I hope it works out - each time they refuse, ask for an appeal (fax paperwork if you need to) and ask for someone higher than the person/group who denied it. LOTS of insurance companies are denying things the first 2 or 3 times they are submitted now. Resubmit, appeal, do whatever you need to do.

    Why would eating disorders be treated differently from other mental illnesses?
  10. smallworld

    smallworld Moderator

  11. Jena

    Jena New Member


    i'm a bit calmer now got back from visiting hours at hospital. had to tell my ex h that tmrw we mite be discharging her and taking her back home. honestly at this point i think i'm just a bit beaten down. between truck breaking down twice on us just trying to get out here, than the insurance battle yesterday than it being ok, difficult child at me all night last night and day today via cell phone calls, and now discharging her tmrw. umm yup i'm beaten down.
  12. Jena

    Jena New Member

    in the a.m.i have to call the head office for the insurance company and talk to the pyschiatrists they have, i told ex h to do the same. if i can't convince them tmrw. to overturn it i have to take her out tmrw and take her home. it's just insane.

    tonight she cried when we visited. i expected that. was the first time she saw her dad since in there. there are only a handful of girls staying there now because alot of kids are on the other level and their able to sleep home and just spend their days there. so when we were leaving the nurse i like was leaving unfortunately and no one other nurses were providing a buffer so we could leave her. so i went and sat with-the other girls saw how their day was, they were all going to watch a movie on their labtop. so i said oh wow that's cool, and said can difficult child watch with-you cause we're leaving.

    so these sweet girls walked into her rm and said difficult child do you want to watch a movie with-us? she kinda didn't say anything so i basically took her by her hand and brought her into their room. she sat with-them a bit and than snack time came and she refused to eat the yogurt. so they made her sit for an hr. with-it and they finally gave up. she went back to her room and cried and called me crying and bashing me again.