Panic time: precertification standoff

Discussion in 'General Parenting' started by recovering doormat, Dec 22, 2008.

  1. recovering doormat

    recovering doormat Lapsed CDer

    my difficult child 2 15 yr old son has been accepted to a facility in Pennsylvania that treats dual diagnosis kids (he smokes weed, refuses school and won't obey house rules) but we're hung up on the insurance precertification: the admitting facility requires that the insurance carrier pre-certify him for services, but when I called the insurance carrier they say they don't precertify until the admitting facility has had a face-to-face evaluation of the patient and then calls in for precertification.

    Have you ever heard of a situation like this? my ex and I spent a week chasing the school district around to get them to pay for the educational component, and they finally agreed to it today, and now we can't get the insurance carrier to agree to let him in.

    Yikes, is all I can say.
  2. Critter Lover

    Critter Lover New Member

    I am sure your insurance carrier is looking at the facility the same way if you were to go to a hospital. If the doctors feel that you need to be admitted then the facility would know that they need to call for recertification at the time of admittance. At least you know when you get to this facility that they need to do this and you can remind them that your insurance requires precertification before admittance....and the facility will do it......cause they know if they don't....they will not get paid.

    The only reason the insurance carrier is saying face to face evaluation because they want to make sure that he will definitely admitted. Good luck with the process and hopefully you will have a good outcome.
  3. recovering doormat

    recovering doormat Lapsed CDer

    Yes, that makes sense. If the insurance company for some reason says "no" then we can still admit him, but we would have to give them a huge check up front, I would imagine, since neither of us have a credit card (casualty of the divorce wars). At least the school district is agreeable to covering his education expenses, which are $200/day.