LIVID. Overdose to IOP level of care just like that!?

Discussion in 'Substance Abuse' started by comatheart, Jul 23, 2014.

  1. comatheart

    comatheart Active Member

    I haven't been back to update, we are in the process of moving and things are CRAZY around here.

    My difficult child went back to treatment last Tuesday. Directly from the mental health hospital to the treatment center in TX. He's been there 8 days and they are saying the insurance company already wants to drop his level of care to IOP.

    SERIOUSLY. He spent 9 days in ICU, 7 of those on a ventilator from overdose. Another 8 days in the mental health hospital and now and they think he's ready for IOP after 8 days back in rehab????????????????????

    I know at least one of you (can't remember who) here has written appeal letters to your insurance co before. Would you be willing to help me out? I don't even know where to begin!
  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    It wasn't me who said that, but we have done it, however it works MUCH better if the doctor will call and make a plea for it. We didn't have any effect, but the doctors did. Talk to your son's doctor immediately. It's sad how fast they want to rush sick kids out on the streets again. I'm sorry.
  3. dstc_99

    dstc_99 Well-Known Member

    I am no help on this but I wanted to say I am so sorry you are having to deal with it. I really hope your insurance doesn't kick him out and that difficult child gets the care he needs.

    Sending prayers.
  4. lovemysons

    lovemysons Well-Known Member

    Oh my coma,
    I can only imagine what you are going through between your son's welfare, moving, and now this Appeal process. I am so sorry that Ins co is behaving this way...but not surprised.

    I have written a letter of Appeal before but coma it was like 12 or 13 yrs ago...I don't even have the letter I think anymore as I threw away so many bad memory things.

    First I would just start writing down all the ways in which your son has been a danger to himself or others. Write it like a story...a very personal and tragic one. When I wrote my letters I absolutely felt that I was taking part in saving my son's lives. It was an emergency! I needed them to "know" my son's...who they were before drug addiction and after.

    List everything...and expecially the overdose and the seriousness of it. You are appealing to the hearts and minds of these people. I hope they will be compelled to give your son more time in Rehab. I think I "bought" an addtional 2 to 3 months for each of my son's.

    I'm sorry I can't be of more help right now. If I think of anything else or find the Appeal letters I wrote I will certainly let
    you know.

    love and hugs to you...and I am so pleased to hear that your son made it through. I hope he is even more than willing now to really surrender his life to sobriety.

  5. Childofmine

    Childofmine trying to do this thing one day at a time Staff Member

    Mental health benefits are a crime in this country. It is unconscionable.

    I understand that most insurance companies will approve only 7 days at a time for detox and rehab. If they pull the plug 7 days in, and the desperate family wants the person to stay there, then THEY have to pay.

    It is immoral.

    I am so sorry that you are having to deal with this.

    Yes, please call down there and talk to the doctors, administrators, everybody and see what can be done.

  6. FlowerGarden

    FlowerGarden Active Member

    No advice but I hope you appeal and win. Hugs to you.
  7. Kathy813

    Kathy813 Well-Known Member Staff Member

    I have found that letting the doctors and therapists deal with the insurance company nets much better results. We were recently told that my difficult child's insurance would not cover detox. Period.

    So when the IOP that my difficult child is currently in decided that she needed detox to come completely off benzos, we told them that the insurance company would not pay. Next thing you know, the therapist tells us that the detox hospital that they work with said difficult child could go there and would be covered 100% under her insurance!

    Even the IOP coverage is 100% which we can't understand since we were directly told that our difficult child's insurance care did not cover more than two sessions a week because her marketplace insurance was not the same as people that were covered by Humana by employers (which is a crime and I don't understand why this hasn't been covered by the news media). When we told that to the therapist, she told us that she didn't understand why they told us that since their person who works with insurance coverage had no problem getting difficult child approved for five days a week.

    So the moral of the story is that you can be told one thing by one person only to have another person tell you something completely different. I would ask that the doctor or therapist tell the insurance company that your difficult child needs a higher level of care than IOP right now.

  8. Nancy

    Nancy Well-Known Member Staff Member

    I only had to appeal the process once and my doctor did it for me. When difficult child was in rehab the rehab dealt with insurance and convinced them of the need, but of course that didn't help much because of our enormous deductible.
  9. comatheart

    comatheart Active Member

    Thanks everyone. We'll get the official word on Monday. I hope the case manager who said that actually read my son's file since she verbalized she would be recommending IOP at the next review. It's just so absurd! We are being told the doctor and counselors at the treatment facility are fighting back. In the meantime, his local Psychiatrist has agreed to fight as well and I am working on our appeal letter. I'll keep you updated.
  10. in a daze

    in a daze Well-Known Member

    This is beyond the pale. It's just unbelievable. It's inappropriate. Complete lack of clinical judgment. I'd be curious to know what kind of insurance you have.
  11. comatheart

    comatheart Active Member

    We have BCBS.

    The good news is the Dr. at the treatment center got him some more time!
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  12. Kathy813

    Kathy813 Well-Known Member Staff Member

    Did you hear anything yet?
  13. comatheart

    comatheart Active Member

    Yes Kathy, see above! :)
  14. Childofmine

    Childofmine trying to do this thing one day at a time Staff Member

    Coma, I hope you can relax for a while. You deserve it. Lean in. He is in good hands, and let the professionals do what they do.

    You rest and renew yourself. Warm hugs.
  15. Kathy813

    Kathy813 Well-Known Member Staff Member