Insurance won't pay for detox, detox says he doesn't need it, any ideas?

[FlowerGarden]

difficult child recently admitted he has a substance problem with pot and pain killers. Our insurance says he doesn't need inpatient. He can detox on his own and attend outpatient. He called a place for detox and they said he isn't addicted enough for them. difficult child says he cannot do it on his own. He has tried a few times and can't get past the second day because of the pain is so severe.

Does anyone have any advice or suggestions on how to get into an inpatient program? Even the police detectives in town have said it is hard to get into inpatient detox. They recommended that he lie and say he has a more severe problem than he does.

 

[buddy]

geepers, my neighbor just decided to go to detox and bam, it was a done deal.... I guess saying he is worse than he is, is a thought...I mean it is really crazy to me that they wouldn't want him in patient in case he got sick or had pain. Is there any way to do a planned withdrawal with a doctor, little by little if you are doing it out patient? I dont know enough about addiction to know if that is realistic. Others here do know and I am sure will help much more...I had to go little by little off a medication that my body was dependent on but I am not an addict so it was easy to do and I did it faster than they thought it would go, but there was no pain that way (there was when I had a pharmacy issue once and ran out of medications suddenly, I remember that! it was awful and I believe him that he can't do it on his own) Or, can he receive medications that can be taken out patient with your help during the detox phase?
I'm so sorry that is happening at a time when he is ready to do this...seem so frustratingly wrong.

 

[Nancy]

I found it was easier getting difficult child into detox through a private treatment center than through a hospital. If you enter a treatment center, they require you to go through a few days of detox. After she was released and eventually relapsed she called several detox centers in the city and none of them would take her because they said she wasn't bad enough. She was able to detox herself and entered a sober house, but if we had had the money she could have gone back to the treatment center and they would have put her in the detox unit.

We were able to get the treatment center covered by our insurance but because of our deductible and the limits of the policy they only paid $3,000 of the $25,000 cost.

It's a real shame that we can't provide better health coverage to those who want help without bankrupting the family.

Nancy

 

[Andy]

I work in the detox and in-patient Chemical Dependency world. My facility used to have the detox section but that has since been handed down to a different facility.
Anyway, for our purposes, detox is like an emergency room. The person has to be in immediate medical need of detoxing. A planned detox will not be considered. If your son is not showing withdrawal symptoms until the 2nd day, I would suggest that he plans on presenting himself for admission on the 2nd day while he is in the midst of the pains. Have him arrange for someone to be with him who can drive him to detox and present as not able to function. At that point he will most likely be begging for the chemical that he needs to withdraw from and that will also add to his case. An assessment will be made on his immediate need to get through this step and hopefully the insurance company and the center will agree that he needs help.
If he can get into the detox as he is withdrawing, the staff should then be working with him to determine how to prevent this from happening in the future. Hopefully the findings will support in-patient care.
Another thing would be to contact your county's social service department (I don't know if all U.S. states offer this, but worth a look - All counties in Minnesota do) and ask for help in finding chemical dependency services. The county will make an assessment to determine if they believe he is in need of treatment and if he is eligible for funding from a certain fund if the insurance denies.
The next step if that is a no-go is to go to the in-patient facility directly and ask for an admission assessement. That person should be able to explain what criteria they look for to make the determination of need.
If all that fails, I would suggest going the out=patient route. The person who works with him in out-patient will be able to recommend in-patient if he/she sees a need and their documentation will help open the door. (we do have people who start in out=patient and transfer to an in-patient program)
I do not work with the direct care/medical side of my facility so am unable to answer questions as to what is needed to meet criteria. That criteria may differ from place to place so keep looking and asking - don't assume all programs will give the same answer. (I work with the financial side, collecting the funds to pay for the Chemical Dependency programs our facility provides.)

 

[FlowerGarden]

Thank you for the responses. I just can't get over how one person can tell a person suffering that they do not need help. Everyone has a different level of tolerence to pain, etc. How can someone say to another, you aren't suffering enough for us. I didn't think of trying the county.
It is nice to have a place to come to and know you will get good advice.

 

[Nancy]

Andy thank you for that information. We did start out in outpatient after she was assessed and determined not to need inpatient. She lasted two days when I told them I was paying $500 a day for nothing because she was drinking every night, coming home at 4am and going to outpatient with glassy eyes and alcohol breath. They didn't even notice (rolling eyes). The counselor agreed she needed inpatient and was able to make a call to get her admitted. Like I said it didn't do much in the way of financial help for us, but you are right, outpatient is a way to open the door.

FLowerGarden, if you do go this route, be his advocate. The outpatient team was willing to keep her there for the duration I believe. They were completely unaware that she was faking it. I had to go in and tell them what was really happening and that she needed something more.

Nancy

 

[FlowerGarden]

Nancy,
I think my difficult child would pull the same thing. Thanks for the heads up.

 

[DDD]

Do you have any MD's in the area who specialize in substance abuse? It "may" be possible to find an expert who can help with a withdrawal plan. Depending on the drugs involved there is a possibility that he can do it outpatient with-o any danger to his system....difficult child#1 has a friend who is in his second week of self withdrawal and is restless & irritable but not in pain. I think alot depends on which drugs you are dependent upon and the quantity your body is accustomed to having. Of course after the physical withdrawal there are years of psychological withdrawal, change of friends etc. that make it a lifelong problem. My Dad joined AA when he was around forty but even twenty years later he would get stressed and seek out a meeting. The insurance companies are rarely ready to step up to the plate for inpatient and once a patient is received at a facility seek to establish that they should be discharged since they are "no longer using". Makes no sense. It's terribly sad and I feel your pain. Hugs. DDD

 

[Ephchap]

FG,

I have totally lived through it and I also don't understand why the system is not set up to help those who are ready for help. My son was 17, had finally gone into a substance abuse hospital while we were working on a long-term residential placement. The director and his immediate case worker knew this and we had verbally agreed on a 21 day stay.

By day 12, they said he was ready to be released. In digging further, it wasn't so much that he was ready, but that he no longer fit the criteria of a critical or emergency need, so the insurance carrier would not cover it. I called the insurance company and I can still remember screaming into the phone (yes, stress and worry and all those things combined) and asking how someone sitting at a nice desk in a cushy job could determine my son was no longer in need.

I got nowhere, unfortunately. The hospital did release my son on day 12. He came home, ate dinner, took a shower, and the next thing we knew, he had gone out one of the house windows and ran. He was arrested that night for a felony, at the grand old age of 17. The judge denied him the HYTA Act which would have meant the felony was wiped off his record once he reached 18.

He was not ready to be released and I again called my insurance company, for all the good it did. We were able to secure a residential bed for him in a dual diagnostic (psychiatric and substance abuse) long term (he was there for 10 months) through our MHMR Agency. They pushed him through by having him fill out paperwork for social security, where they based it on his income ($0) and had us supplement it by what they deemed we could afford, based on our income. It was a long process to get to that point where they'd take him into the residential facility, but it literally saved his life (and our sanity).

If you have any agencies that work under your county or state MHMR AGency, see if someone there can point you in a direction to get assistance.

Hugs to you. I know what a difficult road this is.

Deb