Exhausted Benefits

[dadofCMW3]

If anyone can give advice?

My difficult child is 8 yrs old, he has been in inpatient treatment for 30+ days. Our insurance only covers 30 days inpatient and 52 psychiatrist/Therapy visits/yr (covered by Magellan, we are in Ohio).

He is currently in the hospital now, and since he entered with 2 days of coverage left, the hospital will write-off all days beyond 30 for this visit only. But any new visits will come at a $1200/day tab.

Dr is recommending that he needs 3 months of intensive treatment (out-patient) but not residential right now. I'm told I make to much money to qualify for medicaid or SSI or disability, but not enough to fork over $1200/day inpatient or $395/day full-day out patient, for more than a month.

He has many different diagnosis, some wrong, some set us back a month or two. Current working diagnosis is bipolar, with no ADHD or Depression.

I'm looking at a bill of $395/day x 5 days/week x 13 weeks = $25,675. Yikes!!!!!

 

[ediwiz]

I am so sorry you are going through this, I don't have any real suggestions. Are there any Mental Health agencies in Ohio who will help advocate for you? Have you contacted your State Attorney General's office? They can be very helpful, well at least they are in Minnesota.

 

[bigblueagain]

we too faced this problem with our difficult child until we had coverage thru Magellan. They balked at our residential placement first, until my husband's then employer called and pushed for them to approve. IF your employer is a self insured company(meaning they use their own $ and Magellan does not carry any of the risk) you could lobby them to extend benefits. You can say it would save continued inpatient days as a bargaining tool(even though you are about out of them). In actuality your coverage is very liberal however. I now work for a third party administrator of mental health/substance abuse benefits, much like Magellan, and even though our employers are all self insured, none have benefits like yours. So I don't know how far you may get. I would explore the state's Kids First or CHIP type coverage(for those children who are uninsured or underinsured).BLUE