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Substance Abuse
Insurance won't pay for detox, detox says he doesn't need it, any ideas?
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<blockquote data-quote="Andy" data-source="post: 479656" data-attributes="member: 5096"><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>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)</p><p>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.)</p></blockquote><p></p>
[QUOTE="Andy, post: 479656, member: 5096"] 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.) [/QUOTE]
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Insurance won't pay for detox, detox says he doesn't need it, any ideas?
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