Getting insurance companies to pay for Residential Treatment Center (RTC)

Discussion in 'General Parenting' started by MrConcerned, Apr 29, 2015.

  1. MrConcerned

    MrConcerned New Member

    Does anyone have any advice for how to get insurance companies to pay for Residential Treatment Center (RTC)?
    My girlfriend's Difficult Child was hospitalized for threatening me with a knife. He was in for 2 weeks, then sent home with no changes but an upping of the medications. The insurance company would not pay for Residential Treatment Center (RTC).

    Difficult Child has been diagnosed with ODD since early childhood and now has full-blown CD, with behaviors such as assaulting people, stealing, lying, running away, cruelty, etc. Difficult Child will now not speak to latest therapist, and the therapist suggested hospitalization. No one will pay for it.

    A psychiatrist friend said that insurance companies typically will pay for Residential Treatment Center (RTC) after 3-4 hospitalizations.

    What have people here done that successfully got an insurance company to pay for Residential Treatment Center (RTC)? Does it take police intervention multiple times?

    Difficult Child has terrorized his younger brother. If the younger brother can describe dangerous abuse to a therapist, does that carry any weight?

    Thanks everyone.
  2. FlowerGarden

    FlowerGarden Active Member

    Insurance generally doesn't pay. We had to get the police involved and taking Difficult Child to the ER every time he started acting up. The psychiatrist at the hospital got the court involved. Difficult Child was ordered by the judge to go into residential. The residential part was paid by (I can never remember which is right) Medicaid/Medicare. The educational part was paid by our school district and the medication and doctors were paid by our medical insurance.
  3. MrConcerned

    MrConcerned New Member

    Was the Medicaid/Medicare need-based? Did you have to have a income below a certain level to qualify?
  4. FlowerGarden

    FlowerGarden Active Member

    No, didn't have to have an income below a certain level to qualify. It has something to do with the fact that he would be living outside of our home. I didn't understand it all but it was the social worker from our state's mental health agency that explained how it all would work.
  5. confuzzled

    confuzzled Member

    I THINK that once they are out of the home for either 30 days +1 or a full calendar month +1 that they qualify for Medicaid and SSI on their own accord, meaning that your income no longer factors in. (presumably the diagnosis/hospitalization qualifies them on the medical end). I vaguely recall that the SSI portion is a small stipend, like $30/month, so the money isn't the important thing, its the access to the Medicaid that is gold. its been a long time for me so my memory may be rusty--please check into it yourself. if that is in fact still the case, your (non-paying) insurance becomes primary and Medicaid is the secondary insurer. before you went to any Residential Treatment Center (RTC) you'd want to verify they are a Medicaid participant so that it all works as planned.
    hope that helps!
  6. DawnMM

    DawnMM New Member

    My daughter gets medical assistance due do her Autism diagnoses. She doesn't need Residential Treatment Center (RTC) though. My son's Residential Treatment Center (RTC) was paid by the state we adopted him from. You may want to try to get the medical assistance as that might help, still they won't pay until you try other things first.
  7. MrConcerned

    MrConcerned New Member

    thanks for the information. did you adopt the child through the state, or was it a private adoption? The kid in question was adopted but it was through a private placement.
  8. DawnMM

    DawnMM New Member

    We adopted through the state.