Where can you make reservations for a padded room???

[ksm]

I decided to call the company that manages our insurance mental health benefits. I hadn't formally started the appeal process as they are requesting school testing results first. So had been working on that (and banging my head against brick wall) So I call the number on the back of the card and asked... ok... I am trying to get things done that was requested on the denial. BUT, in the mean time... what are we to do when difficult child is in melt down mode, yelling, screaming, throwing, trying to run out of the house. Basically told... take to ER or call police. By then she had pulled up a copy of the letter, read it, and then said... Cenpatico manages the funds for mental health. Healthwave 21 manages the funds for medical health. Since the neuropsychologist requested the testing based on possible brain disfunction based on prenatal alcohol use, the medical health fund should pay for it. I asked for the depart to call for that (they manage quite a few different state ins) and she didn't know. So now, I have called the neuropsychologist back and left a message to see if they can try to refile it to the medical insurance and get preauthorization. I called the medical side - but the recording said every one was in a meeting! Could it be a Christmas luncheon??? I am getting furious. KSM

 

[Methuselah]

Is the padded room for you or the insurance company?

This article may help your appeal: How to Appeal a Health Insurance Denial - Health - WSJ.com

 

[InsaneCdn]

I hate the split between physical and mental health... we have that here, too - in what is supposed to be an integrated public health system.

At least there is another avenue to go pounding on the door for...

 

[ksm]

OK - I called the number for medical health benefits and got some one to tell me more info... I got a fax number for the neuropsychologist to send info to and ask that it be preauthorized under medical benefits. I called neuropsychologist's office to tell them this and got put on hold. Then she said they would call me back to get the number. Still waiting. One hour 20 minutes. Can this day get any better? Yup. difficult child it out of school in 45 minutes.

I found the new boots I gave her this morning, back in their box and in my closet. I guess she does want to wait til Christmas. KSM

 

[InsaneCdn]

I found the new boots I gave her this morning, back in their box and in my closet. I guess she does want to wait til Christmas

But you DID give her an early gift... you "told" her that you DO hear her... that you know she needs another pair of boots...
The important part was the message, not the boots... the boots can wait.

 

[Liahona]

The Residential Treatment Center (RTC) difficult child 1 was at has one. They'll probably let you use it during school hours when the kids aren't there.

 

[buddy]

yikes. I had no idea they separate it for those two things... As crazy as I get sometimes searching for things with MA here, and pre-authorizing the same medication over and over and over..... It all goes to one spot and after two different posters talking about insurance, I am going to say a thank you prayer tonight. Only had issues finding an ortho but ended up at the University and they were great anyway. I am just sick for you to go thru all of this. It is just not right.

 

[ksm]

Last year when I had an issue with their insurance not paying for glasses (which is covered and we had not gone over the limited amount) I called the Kansas Insurance Commissioner's office. Guess what? They only deal with "private" insurance... not state insurance. So the people who are usually least able to advocate for themselves or children don't even get any help from the ins commissioners office! Our state then hires a company out of state to "manage" the state insurance. It is a vicious circle of frustrations. KSM

 

[buddy]

government at its best. Yet to balance the budget, we cut programs for the poor, increase rates for them and then the dingbats add all these middle men into the fold....it is just crazy making.

MN decided to have all disabled kids on MA automatically enrolled in medical plans. Then you "get" to have a coordinator, and you "get" to go thru them for referrals and to get prior authorizations to get prior authorizations... instead of going straight to the doctor.

I found out yesterday I can opt out. Than heaven. I asked what the benefit would be??? well, they will pay for a gym membership. OK, but you have to pick one of the plans, it only has a few doctors compared to the ENTIRE state and I looked up Q's docs, hospitals and therapies....ONE was on there.

How exactly does this safe them money anyway. I just dont see how all the start up costs, plus the people they have to hire to get people into these programs and then the extra people in the individual insurance programs .... how exactly does that reduce costs? I can see for people who do not have an advocate and need help with resource, like the disabled adults themselves. This program was originally started for them. and it was also voluntary. I am so glad to find out that I can opt out. It would absolutely ruin all the things I have worked so hard on in the past and now.

I get it that we should be happy we even have doctors. I really do, I know there are people in the world without any medical care. But I can't help wanting to help my son to reach his potential and not just anyone can help us do that.

I really hope this is the way to get the neuropsychologist done. NOW there is one thing you would think no matter what, would pay off for them. To have someone not have to go from one inappropriate intervention to another.... help them find and reach the correct people to help with their diagnosis.



Keep on keeping on..... (they should be out of the christmas lunch by now..... sigh)

 

[TerryJ2]

Very interesting distinction. Glad you are working on it. Soooo sorry it is so frustrating.
But when you talk to the neuropsychologist office again, don't ask, give a simple command statement, in a nice voice, "This is what you need to do." Just a suggestion.
Best of luck on getting that padded room. Can I have the reservation the week after yours?