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Plenty of "newbie" Residential Treatment Center (RTC) questions
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<blockquote data-quote="Farmwife" data-source="post: 382102" data-attributes="member: 8617"><p>Such a short and sweet way to express what I have been feeling and sensing. I knew there was a magic trick up their sleeves.</p><p> </p><p>On the plus side I think the insurance is a maybe. Maybe is good, maybe is not a no so I can work with it.</p><p> </p><p>On their website coverage literature it comes down to two things, medical neccesity and diagnosis. Can't speak to a human until Monday.</p><p> </p><p>Diagnosis may need to be tweaked because they had depressive stuff and BiPolar (BP). difficult child is cyclothemia which is a close cousin of both and pretty much a more specific diagnosis in that family. I know psychiatrist will work with me on the dreaded label lingo to get him in and recent psychiatric hospital stay is a good way to justify it.</p><p> </p><p>Medical neccesity is up to psychiatrist, again a non issue with regular doctor but not sure psychiatric hospital doctor will be on board. Then the MH unit of our ins. looks it over. They don't have to agree that it is neccessary and may not since again, difficult child is an angel and they won't be able to predict his next violent assault. We can argue that the very nature of his disorder is being unpredictable and that we cannot offer stability in our home and community. At that point I can thank them very much for a history of paying generously for counseling that didn't prevent said assault...<img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" class="smilie smilie--sprite smilie--sprite2" alt=";)" title="Wink ;)" loading="lazy" data-shortname=";)" /> </p><p> </p><p>After surviving and winning a brutal 9 month war for the IEP an insurance company just poses as a mere amusement for me in my time of from real worries. <img src="/community/styles/default/xenforo/smilies/tongue.png" class="smilie" loading="lazy" alt=":tongue:" title="tongue :tongue:" data-shortname=":tongue:" /></p><p> </p><p>The best part is that the determining agency is NOT a part of our insurance carrier. They are independant and run by no one less than a licensed counselor but have a lot of MH staff manning the lines. I called once for advice and they were very kind and willing to help. Cost was a non issue for them we just weren't this bad off back then so didn't really qualify and I agreed.</p><p> </p><p>Once/if approved our coverage is very generous and our deductables managable.</p><p> </p><p>The approval process is repeated for different things- admission, time of stay and something else I forgot. Though it is a lot of steps they also have a very patient friendly appeal/grievance process. There are even provisions for emergency determinations and/or appeals with an answer in 24 hours so we don't get stupid delays that prevent care.</p><p> </p><p>As I see it the cost of an attorney for the appeal process is a small fraction of the cost of me paying out of pocket.</p><p> </p><p>I am sooooooo doing this and someone is soooooo helping me cover it. Mark my words. I am done messing around with agency games. I am done spending years looking up boarding schools and sobbing when I see the tuition rate.</p><p> </p><p>I know my rights. This warrior Momma is JUST getting reved up. I have to thank the dink school admin for the iep drama. That was perfect basic training. I have never been so determined and confident in my life. I think I feel downright cocky today.</p><p> </p><p>Amazing what a couple days away from difficult child can do...</p></blockquote><p></p>
[QUOTE="Farmwife, post: 382102, member: 8617"] Such a short and sweet way to express what I have been feeling and sensing. I knew there was a magic trick up their sleeves. On the plus side I think the insurance is a maybe. Maybe is good, maybe is not a no so I can work with it. On their website coverage literature it comes down to two things, medical neccesity and diagnosis. Can't speak to a human until Monday. Diagnosis may need to be tweaked because they had depressive stuff and BiPolar (BP). difficult child is cyclothemia which is a close cousin of both and pretty much a more specific diagnosis in that family. I know psychiatrist will work with me on the dreaded label lingo to get him in and recent psychiatric hospital stay is a good way to justify it. Medical neccesity is up to psychiatrist, again a non issue with regular doctor but not sure psychiatric hospital doctor will be on board. Then the MH unit of our ins. looks it over. They don't have to agree that it is neccessary and may not since again, difficult child is an angel and they won't be able to predict his next violent assault. We can argue that the very nature of his disorder is being unpredictable and that we cannot offer stability in our home and community. At that point I can thank them very much for a history of paying generously for counseling that didn't prevent said assault...:winking: After surviving and winning a brutal 9 month war for the IEP an insurance company just poses as a mere amusement for me in my time of from real worries. :raspberry-tounge: The best part is that the determining agency is NOT a part of our insurance carrier. They are independant and run by no one less than a licensed counselor but have a lot of MH staff manning the lines. I called once for advice and they were very kind and willing to help. Cost was a non issue for them we just weren't this bad off back then so didn't really qualify and I agreed. Once/if approved our coverage is very generous and our deductables managable. The approval process is repeated for different things- admission, time of stay and something else I forgot. Though it is a lot of steps they also have a very patient friendly appeal/grievance process. There are even provisions for emergency determinations and/or appeals with an answer in 24 hours so we don't get stupid delays that prevent care. As I see it the cost of an attorney for the appeal process is a small fraction of the cost of me paying out of pocket. I am sooooooo doing this and someone is soooooo helping me cover it. Mark my words. I am done messing around with agency games. I am done spending years looking up boarding schools and sobbing when I see the tuition rate. I know my rights. This warrior Momma is JUST getting reved up. I have to thank the dink school admin for the iep drama. That was perfect basic training. I have never been so determined and confident in my life. I think I feel downright cocky today. Amazing what a couple days away from difficult child can do... [/QUOTE]
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