Schizophrenia & violent teen + Nightmare Insurance Headaches--Update-- - Page 2

[KatWrangler]

So he is on a State Medicaid or a State Medicaid Provider?

[LynnS6]

I hope you can get something worked out soon. I cannot believe the insurance people are trying this.

[rhiandmoi]

Originally Posted by Theoretica

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

Ok. Now I am seriously frakking pissed. The point of these insurance programs is to prevent children from becoming wards of the state while at the same time providing them with necessary and expensive medical treatment.

Is this a direct Medicaid or is it a plan managed by a major HMO?

[anj_rn]

Have you contacted the Medicaid Ombudsman for your state? They were very helpful in getting my DD's stuff covered when MCD said she was not eligible. It was a quick phone call, then they walked me through the process. They told me EXACTLY what the doctors needed to write to make her eligible.

[karne]

I'm still thinking that there must be someone in the senator's or congress-person's or governor's office that functions as a health care liaison who can be tapped for help.

OP, I hope this brainstorming is still feeling helpful to you, and not overwhelming. I feel like we're all sitting around a virtual kitchen table with you trying to offer ideas and support!

[Theoretica]

There's a committee in our senate that is overseeing the medicaid problem-in fact this exact reason is why they created the committee in the first place. I've emailed all ten of those committee members and about 15 other people who seem to be involved in some attempts at checks and balances of this system. I've also emailed the complaints division at medicaid and the HHS complaints division. I've emailed the governor and my representatives. I don't know if any of this can or will matter but at least I'm doing all I can. This is all definitely helping-I really appreciate it and it just feels better to do SOMETHING as opposed to nothing. Even if in the end is the same result at least I'll know I did all I could. Ugh.

[Dr.Worm]

I don't have any advice but wanted to give you a I'm so sorry. Hope it all works out for you.

[charmarty]

Originally Posted by Theoretica

There's a committee in our senate that is overseeing the medicaid problem-in fact this exact reason is why they created the committee in the first place. I've emailed all ten of those committee members and about 15 other people who seem to be involved in some attempts at checks and balances of this system. I've also emailed the complaints division at medicaid and the HHS complaints division. I've emailed the governor and my representatives. I don't know if any of this can or will matter but at least I'm doing all I can. This is all definitely helping-I really appreciate it and it just feels better to do SOMETHING as opposed to nothing. Even if in the end is the same result at least I'll know I did all I could. Ugh.

Absolutely right sweet Mama. Taking action does help! I hope this all works out for you both. You are doing the right thing.

I am in Canada, so a much different system, but not one without some major challenges as well. My sister was dx with paranoid schizophrenia almost a year ago but she is now an adult. Both very difficult situations. I am grateful tho, for the fact that when your son is an adult, there is already a treatment history there, because I know being an adult while trying to get a dx and proper treatment is very very difficult.

Anyone who is sick with this illness just breaks my heart.

You, and your son are in my thoughts and prayers.

[khaoskat]

Originally Posted by 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.

I am probably too late, but the Court can Order Temporary Custody to the Juvenile Court System, and have him placed in RTC, at State's cost, but you will end up paying child support to help cover the costs.

And as for the comment that the insurance company made...even as juvenile, if he beat the crap out of his pregnant mother he could serve time in Detention, Division of Youth Services (basically youth prison in a State facility), or be removed from the home. And an adult in that same case (wife instead of mother) could be removed from the home and placed into jail or treatment.

As for the insurance company, I would start appealing it up to every single level, including throwing out finding an attorney and going after them for "bad faith" practices. You now have multitudes of experts saying that this child needs residential treatment....it is not a simple he got made and hit you...he has a mental health issue(s) or delays that need to be addressed and the appropriate place for those is not in the home, where he can come back and attempt to hurt you again (and you can threaten to sue them for damages if he hurts you again). I would also contact your State's Insurance Commissioner and file a complaint, you have all the back up an supporting documents in your favor.

[SleeplessMommy]

Originally Posted by khaoskat

I would also contact your State's Insurance Commissioner and file a complaint.

i am so sorry. how terrible to not just have a child in this situation, but to have to go to such extremes of advocacy to get him the care he needs.

:cry

[SpottedFoxx]

Another person who just wants to add some big time .

What an amazing and strong woman you are. I'm glad you and the baby are okay and I hope your son gets the help he needs.