Schizophrenia & violent teen + Nightmare Insurance Headaches--Update--

[Theoretica]

Background Post Here

--Update--

He's still inpatient on ICU, and the insurance company is authorizing his stay in 24 hour chunks, with 72 hour chunks authorized on the weekends. His psychiatrist is recommending Residential Treatment Center care (basically a long term locked inpatient unit), which is the highest level of care other than Acute Psychiatric Inpatient. Underneath those comes Treatment Group Home, then Treatment Foster Care, then Home Based Care.

The insurance is DENYING Residential Treatment Care and recommending HOME BASED CARE?!?!? Their reasoning....get this....is that if he was an adult (umm he's not) he'd be inpatient to stabilize medication and then discharged into the community. Umm. No. Actually if he'd beat up his pregnant wife (instead of his pregnant mom) he'd be in jail. Logic FAIL. I talked to them for an hour the other day and pointed out that he wouldn't even be accepted into Treatment Group Home care because he's too violent, and they AGREED WITH ME! But he's safe to come HOME??? WTF?!?!

So they are trying to send him back home to me. And telling me if I don't agree then I can relinquish custody to the state. The hospital and psychiatrist are all working their tails off to get RTC placement approved, they couldn't be more awesome than they are. But the insurance won't budge. The unit social worker recommended I call the county prosecutor, since DS is being charged with criminal offenses.

He called me back

He is filing an expedited motion to court order DS into treatment as recommended by his psychiatrist. Which means the insurance company will be FORCED to pay for it and they can't do anything without approval from the court

It hasn't happened yet, the prosecutor needs some paperwork faxed over from the hospital, and I don't have a vehicle (DH is working all day out of town) so I can't get up there to sign the danged papers to release info to the courts. We're going to try for verbal consent with a witness and hope that works. Then there's time needed for everything to get filed and hearings etc, so it's not over yet and the judge could say no...but this is a HUGE step in the right direction and just to know that I have some legal support for him to NOT come home right now, without being forced to turn him over to the state as a ward....zomg...I can't even tell you the relief I'm feeling.

Thanks for all the support, I'll keep you updated as best I can...

[lotusdebi]

You're in my thoughts.
I really hope it all works out!

[karne]

I continue to be amazed at how strong you are, both as an individual and as an advocate for what's right for your ds!

[Birdie B.]

I really hope everything works out for you and your son gets the help he needs.

[sbgrace]

What wonderful news. I so hope it all comes together for him (and you). What a nightmare.

[BetsyNY]

And people think there's nothing wrong with the healthcare system in this country.

Keep us posted, mama. We're all pulling for you.

[Theoretica]

Argh! Back to square one. The county attorney can get an order for treatment but the insurance can refuse to pay. If they do so we're back to me having to give him up.

[joyluc]

Momma I am so sorry. There should be a way for you to get help without giving up custody. Is your DS doing better in the hospital? Do you have support IRL? I thought I would have to put my DS in residential treatment last fall, it was a terrible feeling.

[Theoretica]

I have the support of my friends, husband etc. But if insurance denies placement than there's nothing I can do. The doctor is recommending RTC placement, which we agree with. The doctor got yet another doctor to look at DS's case today for a second opinion and THEY agree with RTC placement. The COURT agrees with RTC placement.

The insurance company, however, does not.

So apparently it doesn't even #$^&ing matter that two psychiatrists who have personally evaluated my son's case, the prosecuting attorney in Juvenile court, the JUDGE in juvenile court, and me ALL think RTC is the best idea because the insurance company gets to do whatever they want.

[BetsyNY]

Contact your local representative, senator, what have you--TV station! That might do it.

I don't understand--if he's court-ordered, wouldn't the state have to pay if the insurance co. refuses?

[Theoretica]

Yes, the state would have to pay, which would require making him a state ward and I lose custody.

[rhiandmoi]

What Ins. Co is it? Does your state have a insurance regulator? Is it a work policy or a private policy?

[maybemom05]

I'm so sorry this is happening to you!

As another poster suggested, I think you need to involve your state's consumer protection folks. Your state representative's office should be able to help you to work with the state's insurance regulator - or possibly the attorney general's office - to get the insurance company to co-operate.

Also, is this insurance through an employer? If yes, then it might be worth while to get your employer's HR department involved - often they can but you in touch with someone more helpful, and with more authority, than the folks at the 1-800 number. (I realize this is a sensitive issue, so you may prefer not to involve work, but it might help keep you from going in circles)

Good luck to you!!!

[KatWrangler]

Oh I would raise Holy H*ll. The insurance company doesn't want to pay because they know you can relinquish rights to the State. The the insurance company is off the hook and the State has to pay the bill.

Call your State Insurance Commision this morning.

[karne]

I agree w/the above. I can't imagine what the press would look like if a woman was being forced to take in her abuser because insurance would not pay for appropriate treatment. I don't mean to sound harsh, or not be aware that the steps you are taking are based on the love you have for your child and his need for safety and treatment. But you are pregnant and have been assaulted, and the ins. company is setting up the pieces to allow the same thing to happen again. I would think about calling your state rep, congressperson, governor's office, etc. There must be a task force on domestic violence w/in one of those offices. You need to scream about this to everyone-I'd be thinking of a news reporter who covers local and domestic violence issues. It's wrong, wrong, wrong on the part of the ins. company. And, it is incredibly wrong that as a woman, pregnant, and trying to help her child before the next crisis comes, that this s happening to you.

[Theoretica]

Awesome advice everyone, I'm working on what is so far a 10 page letter to the insurance company, cc'd to the 9 senators in the insurance oversight committee for our state, the governor, the hospital, and the state insurance commission.

Keep it coming!

[theretohere]

No advice, just more .

[karenstir7]

I tend to be a lurker here but I wanted to send you big hugs. I have thought about you daily since your original post. Many prayers are being sent out that the insurance company will do the right thing and you can help your son.

[rhiandmoi]

Another thing to find out is if you can get him qualified for Medicaid or another state program and thus the inpatient treatment under a Children with Extreme Illness program (they have different names in different locales, I would ask a caseworker).

[Theoretica]

Originally Posted by rhiandmoi

Another thing to find out is if you can get him qualified for Medicaid or another state program and thus the inpatient treatment under a Children with Extreme Illness program (they have different names in different locales, I would ask a caseworker).

That's who we're fighting. He's uninsurable through private insurance.