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Insurance question - Update
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<blockquote data-quote="Ephchap" data-source="post: 504414" data-attributes="member: 27"><p>Hi Goldie.</p><p></p><p>Our situation was a little different, as my son had just turned 17. It was one of those gray areas, where the police and court system considered him an adult, but the health insurance and hospitals and rehabs considered him an adolescent.</p><p></p><p>He did go to an adolescent substance abuse hospital, and our insurance (which he was still covered under at the time) did cover his stay. However, even though we had agreed to 21 days with the director of the program when he was admitted (as we told her we were looking for a long-term placement), he was released on day 12, as the insurance carrier said he now had all the tools and could do outpatient. That night he went out the window of our home, was arrested and has an adult felony on his record to this day. Yeah, thanks insurance carrier. He was really ready. Ughhh.</p><p></p><p>We did end up having him evaluated once again, and found a place after making what seemed like a hundred phonecalls. I finally got someone at one of the hospitals substance abuse floors for adults that recommended I contact a certain agency that dealt with our county's MHMR. They evaluated him and agreed he needed dual-diagnostic (both psychiatric and substance abuse) long-term residential care. Our insurance carrier would not pay for anything that was considered a residential stay. The agency had us fill out paperwork to apply for SSI for him. It was based on his income (zero). As a minor living in our house, however, they also had us fill out paperwork, and they determined what we could pay. We appealed that and had the amount lowered, as by then I was not agreeable to throwing more money out and we had two other children had home. He was placed in a great facility about 2 hours from here, and he stayed there 10 months - just up until his 18th birthday. He could have stayed longer since he was already in there before turning 18, but they (and at that point, we did too) felt he was ready to transition home.</p><p></p><p>Again, this was all very different since he was a minor. However, there are agencies that will help and that deal directly with MHMR and other agencies. The hard part (sometimes futile) is finding someone or some agency that will help.</p><p></p><p>It should not be this difficult when someone is finally ready to get help. Unfortunately, the sad reality is that it is. Many fall through the cracks and never get the help they need because of the way the system is set up (or, in my opinion, not set up).</p><p></p><p>My heart goes out to you. I know what a difficult situation it is to be in.</p><p></p><p>Hugs to you and yours,</p><p>Deb</p></blockquote><p></p>
[QUOTE="Ephchap, post: 504414, member: 27"] Hi Goldie. Our situation was a little different, as my son had just turned 17. It was one of those gray areas, where the police and court system considered him an adult, but the health insurance and hospitals and rehabs considered him an adolescent. He did go to an adolescent substance abuse hospital, and our insurance (which he was still covered under at the time) did cover his stay. However, even though we had agreed to 21 days with the director of the program when he was admitted (as we told her we were looking for a long-term placement), he was released on day 12, as the insurance carrier said he now had all the tools and could do outpatient. That night he went out the window of our home, was arrested and has an adult felony on his record to this day. Yeah, thanks insurance carrier. He was really ready. Ughhh. We did end up having him evaluated once again, and found a place after making what seemed like a hundred phonecalls. I finally got someone at one of the hospitals substance abuse floors for adults that recommended I contact a certain agency that dealt with our county's MHMR. They evaluated him and agreed he needed dual-diagnostic (both psychiatric and substance abuse) long-term residential care. Our insurance carrier would not pay for anything that was considered a residential stay. The agency had us fill out paperwork to apply for SSI for him. It was based on his income (zero). As a minor living in our house, however, they also had us fill out paperwork, and they determined what we could pay. We appealed that and had the amount lowered, as by then I was not agreeable to throwing more money out and we had two other children had home. He was placed in a great facility about 2 hours from here, and he stayed there 10 months - just up until his 18th birthday. He could have stayed longer since he was already in there before turning 18, but they (and at that point, we did too) felt he was ready to transition home. Again, this was all very different since he was a minor. However, there are agencies that will help and that deal directly with MHMR and other agencies. The hard part (sometimes futile) is finding someone or some agency that will help. It should not be this difficult when someone is finally ready to get help. Unfortunately, the sad reality is that it is. Many fall through the cracks and never get the help they need because of the way the system is set up (or, in my opinion, not set up). My heart goes out to you. I know what a difficult situation it is to be in. Hugs to you and yours, Deb [/QUOTE]
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