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it's all wrong
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<blockquote data-quote="Andy" data-source="post: 381881" data-attributes="member: 5096"><p>I am sorry - I was posting my last response thinking today was Saturday - I take one day off of work and it messes up my internal calendar.</p><p> </p><p>O.K. that changes some of what I posted - you are not working with evening/weekend staff - you have been working with the regular weekday staff who I believe are more in tuned to the client's needs.</p><p> </p><p>First to the insurance - It is very common for insurance to authorize a set amount of time to cover the cost of an evaluation. I think that is what was authorized. Then, when the assessments were done and sent in, the insurance company denied due to not enough cause for medical necessity. So, I have heard that many insurance companies will automatically deny to drop a lot of claims that have people too discouraged to continue. Also, with the documentations the facility should be keeping at each and every meal and in between times, the medical necessity factor may just turn in your favor after today. The facility should send in everything to date in an appeal.</p><p> </p><p>The facility needs to prove to the insurance the extent of the the eating disorder - if they can not force her to eat after a certain amount of time, then there is a need for treatment. </p><p> </p><p>It is hard to watch her struggle with this but it does need to be documented by a professional in order for the insurance company to listen.</p><p> </p><p>Since tomorrow is Friday, you should ask for a meeting (without difficult child) with the head nurse or doctor and discuss your concerns. Be open and present your issues in a objectional (non-personal) manner. "I am very uncomfortable with the treatment of extended meals. It just does not make sense to me - can you explain why you think this will work and now that it hasn't after XXX amount of meals, what will your approach be for today and this weekend?" The honey will attract more information and cooperation from the facility then the angry bee. Ask for their reasoning before introducing your thoughts on how they should proceed. If you still don't like what they plan on doing, then direct them to your research, "I believe my daughter has a food phobia which is different than anorexia/bulimia. I thought the treatment would include.................."</p><p> </p><p>Remember, you are in a very intense highly emotional state and thus may not be looking at the whole picture - you are focusing solely on difficult child's emotions and need the facility to show you the big plan. They should also be able to tell you what to expect and the timeline they estimate each step may take. They are not emotionally involved so talking to them in that state will have you and them talking a different language of termonology. You can state yours and difficult child's emotions but they will not "feel" them. They are not in the panicky, fix me now, mode that you and difficult child are in.</p><p> </p><p>Remain calm and as professional as a mom in your situation can be. I know that you will be. Gather more information from the facility directly before making any harsh quick decisions.</p></blockquote><p></p>
[QUOTE="Andy, post: 381881, member: 5096"] I am sorry - I was posting my last response thinking today was Saturday - I take one day off of work and it messes up my internal calendar. O.K. that changes some of what I posted - you are not working with evening/weekend staff - you have been working with the regular weekday staff who I believe are more in tuned to the client's needs. First to the insurance - It is very common for insurance to authorize a set amount of time to cover the cost of an evaluation. I think that is what was authorized. Then, when the assessments were done and sent in, the insurance company denied due to not enough cause for medical necessity. So, I have heard that many insurance companies will automatically deny to drop a lot of claims that have people too discouraged to continue. Also, with the documentations the facility should be keeping at each and every meal and in between times, the medical necessity factor may just turn in your favor after today. The facility should send in everything to date in an appeal. The facility needs to prove to the insurance the extent of the the eating disorder - if they can not force her to eat after a certain amount of time, then there is a need for treatment. It is hard to watch her struggle with this but it does need to be documented by a professional in order for the insurance company to listen. Since tomorrow is Friday, you should ask for a meeting (without difficult child) with the head nurse or doctor and discuss your concerns. Be open and present your issues in a objectional (non-personal) manner. "I am very uncomfortable with the treatment of extended meals. It just does not make sense to me - can you explain why you think this will work and now that it hasn't after XXX amount of meals, what will your approach be for today and this weekend?" The honey will attract more information and cooperation from the facility then the angry bee. Ask for their reasoning before introducing your thoughts on how they should proceed. If you still don't like what they plan on doing, then direct them to your research, "I believe my daughter has a food phobia which is different than anorexia/bulimia. I thought the treatment would include.................." Remember, you are in a very intense highly emotional state and thus may not be looking at the whole picture - you are focusing solely on difficult child's emotions and need the facility to show you the big plan. They should also be able to tell you what to expect and the timeline they estimate each step may take. They are not emotionally involved so talking to them in that state will have you and them talking a different language of termonology. You can state yours and difficult child's emotions but they will not "feel" them. They are not in the panicky, fix me now, mode that you and difficult child are in. Remain calm and as professional as a mom in your situation can be. I know that you will be. Gather more information from the facility directly before making any harsh quick decisions. [/QUOTE]
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