Insurance costs- appeals

[tryingtobestrong]

Just wondering if anyone had to appeal their childs stay at a treatment center. My son had relapsed and his recovery coach advised him to come back for a 10day inpatient stay to refocus on recovery and get back on track... So he went and was released from detox after a day and was in patient for 3 days when I received a call that our insurance was denying paying his stay from the day he went into inpatient... They said he didn't need that 24 hour support. I was told I would have to self pay from day 2 on... at $1177+ a day... They tried to talk to the insurance company and they still denied it. He was released and relapsed even worse.
We were told that the treatment center is going to file an appeal as well as I and my son wrote a letter as well stating how bad he was. He was throwing up ingested blood, couldn't recall days at a time, etc. In the insurance letter the woman stated he showed no signs of having issues at work??? Seriously he filed FMLA 2x's in a month. SO we are appealing their decision in hopes they will pay for the days he was there or ugh... I owe $1177 for each 5 days... on top of everything else.

Another issue I have is... how can one treatment center charge $1295 for an IOP session (out of network) and the in network one charges $419 an IOP session??

These places take us across. I am disheartened as to how they can charge these prices. How can they sleep at night? Those that run the sober living places and IOP all are in recovery themselves. They have had to know the hell they put their families through and now they turn around and charge these prices??
Thanks for letting me vent.

 

[BusynMember]

Since when do businesses care what people can afford as long as thwy get paid??? Name a compassionate private business.

Going to a hospital may have had more pull with your insurance. I dont know.

I wouldnt put my kid in any rehab I couldnt afford. There are cheap/ reasonable/publicl rehabs where just as many people get sober as those who go to fancy looking ones. You may want to check around. High cost doesnt mean high quality. Plus the patient needs to do the work and incir some of the expense in my opinion. That can happen in any rehab.


I am sorry this has been so pricey for you

Love and light!

 

[tryingtobestrong]

It was an in network treatment center so I should not have had to pay more than my $2000 deductible. However, since the "insurance person" feels my son didn't need the treatment, they are pulling their payment after he was there for 5 days and then I am told I have to self pay... Hoping the appeal works.

 

[BusynMember]

I sure hope so too!

 

[Tired out]

I have a handicapped son and had to write many appeals. So far I have one every single one. Do you have a doctor that will back you up with a letter stating diagnosis and need. example. Jim needed to be inpatient due to internal bleeding and blackouts. The patient needs to be returned to inpatient for his health and safety and for medical care professionals to do a full physical and mental assessment. The source if the bleeding and the cause of the memory losses and blackouts have not yet been determined. Also the appropriate medications have not yet been determined, when they are he will need to be stabilized under supervision.

 

[ksm]

If worse comes to worse after the appeals process, try to negotiate a lower price. Once you get a remittance letter from your insurance, see how much they paid for one day...see how much they wrote off, and ask for the reduced rate. Many times on my BCBS I see what they allow as a contracting provider. Many times, it is half of what is charged.

Good luck. Do the appeal process, over and over. Don't give up at the first no.

Ksm