Todays meeting went poorly. It seems the doctor who has spent a total of maybe 30 minutes with difficult child over the past several days feels he is ready for discharge. Of course I may get to actually squeeze a phone call session out of him before I'm supposed to get difficult child. Maybe not. In our case insurance is not an issue, we are a rare case. Though we have no Residential Treatment Center (RTC) coverage we have UNLIMITED inpatient should there be a medical neccesity. Hospital psychiatrist who does not know the seriousness of our situation because "difficult child seems calm at psychiatric hospital" decided he is stable. Um, excuse me, he almost killed someone a week ago. He has a history of doing this so pardon me if 5 days of kissing up to escape the psychiatric hospital doesn't reassure me. Same psychiatrist who has no long term history or contact with me determines medical neccesity. As far as insurance they are amazing. The actual carrier only covers benefits and payment they are not a part of determining anything. An outside agency manned by psychiatric professionals funnels psychiatric hospital info. Here is what they told me. From inpatient difficult child could step down to day program and from day program difficult child could transition to outpatient. Inpatient = hospital 24/7 Day program = hospital during day, home at night Outpatient = Maintenance level with 1 therapy visit per week Simple enough one would like to think. Here is the fun part. Since I am rural and live over 50 miles from the closest day program there is an automatic default up to the next level of care. (inpatient) As long as I cannot take care of difficult child with JUST the outpatient 1 therapy a week he automatically gets bumped back to inpatient (skipping the stepdown care) and the insurance will pay. Medical neccesity is part of it but only part, the default sort of over rides that. Sorry to be so darn repetitive, it seemed like the hospital counselor thought I was trying to explain the recipe to make plutonium out of common household products. I sort of thought the concept was simple in that even if psychiatrist thinks difficult child is ready for step down he can't discharge yet until I can manage him. Of course I was informed their average visit is a week or less and they are acute care. Sort of like a mental health ER. It's a pump and dump philosophy. Pump full of medications and dump them out the door. While I understand the system is taxed we have coverage that will pay them. I kept trying to point out the violent nature of the incident and difficult child's history and explain that they have to keep him by insurance standards and that while their protocol is to determine neccesity (by psychic vibes and happy auras it seems) our protocol is a bit different from the average joe because of the default/distance. Is it just me or is it totally insane that they want to discharge a cash cow so early? We are like a gravy train, I just don't get it. I don't mean to rub it in because I know how blessed we are but geez. The once in a million that there is guaranteed coverage with no hassle the uninformed doctor is going to be the issue. All I was flippin asking for is time for difficult child to get to therapeutic level and bypass the potential side effect stage. Regardless of this psychiatrists personal philosophy, no trained professional should imagine a violent patient can be stabilized on a new medication in less than a week. I need to know he is safe and sane to come home and considering how fast he flips out when a slight medication change happens, you must see my concern. How do I politely ask the doctor if he will guarantee me difficult child will not go off in the next few weeks and if his malpractice insurance is up to date in the same breath? I'm about ready to call a lawyer. It's cheaper than a casket and burial plot...I'm not kidding either, this is very gosh darned freakin serious.