Insurance carrier less than helpful, cruel is more like it..

Discussion in 'General Parenting' started by recovering doormat, Jan 3, 2009.

  1. recovering doormat

    recovering doormat Lapsed CDer

    Yesterday was the big day, difficult child 2 was transported by his dad to the residential facility in Pennsylvania. We thought just getting him into the car was going to be the hardest part, and it wasn't. What transpired when he got to the facility still has me shaking with anger.

    I had been given assurances over the phone several times since Dec. 2 that residential was covered by our carrier (a separate carrier from the main major medical insurance company we deal with), based on medical necessity, and that 70 percent of expenses were covered after we met the deductible. We'd be responsible for the remaining 30% (of approx. $17K). We were thrilled, because the facility is first rate and is just the place he needs to be right now.

    The facility got assurances that we were covered.

    Yesterday ex-husband and difficult child 2 get to the place for the face to face evaluation prior to admission, and suddenly the carrier announces they are denying coverage. Not based on medical necessity, no: the facility he will be residing in is on the same campus as the acute care hospital he was approved for originally. IT's the same program as the acute care hospital for dual diagnosis, just in a separate building. Ex-husband said you could throw a softball from one building to another, it's that close. However, a town line runs between the two buildings, and based on that, our carrier denied any coverage saying it was ina different district.

    The clinician who evaluated my son spent nearly two hours trying to get someone in charge at the insurer to stop this nonsense and certify my kid for the program. They wouldn't budge, admitted it was a silly technicality and reminding us that we could of course appeal their decision. The clinician, who at this point was so furious he suggested my ex step out of the room, told the guy that they would be screaming about this.

    What got me upset the most was that my ex just broke down and sobbed outside the building, just from his frayed nerves and this latest disappointment. Our son was not exactly thrilled to be entering this place and his parting words to his dad was to tell him how much he hated him. See, I can hear that and it rolls right off my back, because I filter the hate speech out. Dad can't do that, and takes it to heart. The poor guy was so rattled he had a minor fender bender in the parking lot as he was leaving.

    Oh, the upshot was, the carrier certified him for three days only. We have to start this b.s. all over again on Monday. What a system we have, no? I'd like to choke someone. I just can't believe these corporations can play with people's lives like this, and there isn't a blessed thing you can do.

    Our state, Connecticut, has an insurance ombudsman to help residents, usually when they seek an appeal or can't get services. I'm going to contact them Monday, depending on what happens.

    here I thought, we've got a straight 60 days to recuperate at home while our boy does his healing at the Residential Treatment Center (RTC), and in fact it's going to be nearly as emotionally and mentally draining as if sonny boy were home making us nuts.

    Okay, vent is over. Thanks for reading.
  2. Critter Lover

    Critter Lover New Member

    OMG what a crappy day and to have to be at the mercy of an unhelpful
    insurance company sure does tick ya off! I do hope things get better and you get the help for your difficult child. (((((HUGS)))))) for support and man I understand your frustrations. Praying things get better all around for you and your family.

  3. recovering doormat

    recovering doormat Lapsed CDer

    My ex-husband spoke with the clinician who did battle with the insurance company on Friday, and our son's status is that he is only certified til Wednesday. This doctor said our carrier is well known for fighting just about every hospital stay tooth-and-nail, even more so than other managed care companies. Great. My ex pays nearly $11K a year out of his pocket for premiums but when it comes time to use 'em, they won't open their fists.

    This really gets me down. If we have to pay out of our own pocket, the rate is $750 a day, and the facility doesn't give us a break and charge us what they would get from the insurance carrier, we would be responsible for full freight. And that's only a portion of our son's treatment: he really needs to go to a residential school or program when he's done with the diagnostics. I dread him coming home too soon from this hospital program, we just don't have the supports in place to really help him. I really don't want to live through the past six months all over again. We can certainly pull in the juvenile court to add the threat of law to keep him in line, but I don't know if that will be enough to really change his attitude.

    Sigh. I really thought we were going to get him the right help at the right time, for a change. This is so frustrating.