Help paying for residential treatment

[scaredofhim]

The in-home therapist that has been coming to see SS said that he is far beyond what can be done to help him on an outpatient basis and has recommended that he be placed in a residential treatment program as soon as possible. Finally, someone gets it and understands the seriousness of the situation and knows what needs to be done and is willing to pursue it. Bio mom is willing to place SS in residential treatment, and husband agrees as well. The problem is that bio mom is not sure if her medical insurance (Federal Blue Cross and Blue Shield) will cover some of the cost, and as we understand it from the research we have done, residential treatment is very expensive. I was wondering if anyone knew what kind of options there might be to help pay for the care if her insurance refuses to cover it? She is a federal employee and has very good health insurance, but husband and I have read that insurance companies don't like to kick in for mental health treatment. Bio mom makes a lot of money, but says she cannot afford to place SS in residential treatment unless her medical insurance helps with the cost. We cannot afford to help pay for it as husband was out of work for two years and just went back to work in Oct. and we are trying to dig out of a mountain of debt. We have no extra money, and we have no medical insurance yet. I don't think Medicaid will help bio mom pay for the treatment because bio mom makes too much money and has good insurance. Does anyone out there have any ideas or advice? Thanks.

 

[BusynMember]

Before you get nervous, why not find out how much the insurance will cover?

I would also find out which residential treatment centers are run by the state. One of my adoption group buddies has a son who has to live in a residential treatment center and they don't pay anything. The state/Medicaid pays for it. Of course, he was adopted so he has Medicaid...

I would call social services and ask what sort of assistance they offer, since your son is already getting state help through his caseworker.

Hugs!!!

 

[scaredofhim]

I don't think Medicaid will be an option in this case, unfortunately, since bio mom has a very good income and insurance. She was supposed to call her insurance company a couple of days ago to see how much of the treatment cost they will cover, if any, and we have not heard back, but we have SS this weekend and SS has an appointment. with his psychiatrist on Saturday, so we will see bio mom then. The therapist that has been coming to the home told bio mom that she really needs to place him ASAP, and if she doesn't follow through, then she could be held liable if SS does something really bad, because she knows of his problems and they have now been documented by his psychiatrist, and by his hospitalization in Oct, and now by the therapist that has been coming to the home to work with SS. And also by the prosecutor, when bio mom went and had the unruly child paperwork done and then did not file it with the court. But the paperwork is still there, the prosecutor has it in his office and it's in his computer too. Our fear is that she will not follow through and place him in residential treatment, just as she didn't follow through with filing the charges against him. This child has threatened homicide and suicide repeatedly. He's dangerous. He needs to be in a facility where he can get help and where he is not a danger to anyone. When SS was here two weekends ago, he gave husband's email address and password to another kid, and that kid went into husband's email and changed the password and recovery email address and phone number. SS of course denied everything, even when we confronted him with proof. And the same day he did that, he came downstairs and asked us to charge 6.00 on our credit card for battle funds for one of his games, and when husband told him no he had a meltdown. Was upstairs stomping and carrying on. And then SS texted my phone while he was upstairs, and in all capital letters, said, "I HATE THIS F**KIN HOUSE AND I'M NEVER COMING BACK!!" I find it interesting that he texted me and not husband, because husband is the one that told him he couldn't have the battle funds. This scares me a lot!! I kept the text message and I am showing it to the psychiatrist on Saturday. Please pray.....

 

[slsh]

I believe that mental health parity is the law now - insurance companies cannot put special restrictions on mental health coverage compared to coverage for heart disease or diabetes, for example. RTCs are of course a whole different ball game and I would imagine that even if you *could* initially get funding thru an insurance company, their goal would be to get him out of there ASAP via utilization reviews (medical necessity).

In addition to Midwest Mom's suggestions, you can/should check with the RTCs to see what their sources of funding are.

My son's RTCs were funded by a grant through Illinois (a program that has been drastically cut in recent years, unfortunately). Additionally, once he was in an Residential Treatment Center (RTC), he became eligible for SSI because our income was no longer considered (he was considered to be living on his own, even at age 9) and therefore also became eligible for Medicaid. You might check with your state Dept of Mental Health to see if funding is available.

How is he doing in school? Another source of funding is the school district, if they are unable to provide a "free and appropriate public education in the least restrictive environment" (FAPE in LRE). Because of the grant, we didn't have to go this route, but due to the number of increasingly restrictive school placements and his inability to function in any of them, our SD would have had to foot the bill for the whole Residential Treatment Center (RTC) placement eventually if the grant didn't exist. They did fund the educational portion of his Residential Treatment Center (RTC) placement, as should your SD I believe.

This link is to a list of questions to ask potential RTCs. There are a lot of different types out there - some geared more toward a particular diagnosis or a certain level of cognitive functioning. I found it helpful to have a list of questions to start out with and then added my own.

Basically, you're going to have to get creative and make a lot of calls. You never know who will turn out to be a good resource. Good luck!

 

[Jess5277]

I feel like I have investigated every residental facility out there and haven't found any that accept insurance. SOME offer scholorships but I haven't found any that accept insurance. Good luck!

 

[dstc_99]

BIO Mom can also take out an interest free loan from her thrift savings plan if she has paid into it. I have done this on several occasions to pay for larger medical things. All they do is take out a payment from each paycheck. Its basically the best loan you can ever get. You don't lose anything from your retirement and you get to pay for something you need.