lovemysons, thank you so much for your post! It is exactly what I was hoping to hear.
So H and I got back home on Tuesday night. The Family Education Program (FEP) at the rehab facility where difficult child has been for the past three weeks ran from Saturday through Tuesday. It was intense and amazing. I was so impressed by everyone we met there, including the other parents. (There were seven families, and over the course of the four days, we got to know each other quite well.) H and I learned a lot, and had some significant "Ah hah!" moments about how to deal with our difficult child.
On Monday, at the end of the day, we had a family therapy session with difficult child and two counselors -- a substitute counselor (difficult child's regular counselor is on vacation this week, which is okay) and a clinical supervisor. I was blown away by that session, and so happy that difficult child is working with these people. The clinical supervisor met with H and me beforehand, and coached me on how to try to get difficult child to disclose a significant secret that he had been keeping from us. (I had suspicions about this secret -- having to do with how he earned money to pay for drugs during his two months of couch-surfing -- but did not know anything for sure.) difficult child did open up to us, and it was a very moving moment. I felt as if I could almost see the waves of anxiety flowing off him, at not having to keep this secret any longer.
I was also impressed that it took only about a week and a half after arriving there for difficult child to realize that he did need extended care. I knew that going in, and we did not hide it from difficult child, but I knew he was hoping he would just do the 31 days and then be able to come back home. That would not be good; his triggers are his friends here, and there is not one of them who does not do drugs. His girlfriend is probably the worst offender; he has seen her do heroin. (He has not tried that, but recognizes that it could be down the road if he continued to hang out with his old friends. Despite that insight, he is still focused on the girlfriend, whom he loves and wants to rescue, so his coming back home at this point would not be good.)
The facility has just made its recommendation for extended care. I was impressed by the thought they put into that. difficult child will be going to a facility down South (we're in the NE), and from what I have read and heard about it, I think it will be a good fit for him. He is actually pleased with the choice, and is very willing (5 on a scale of 1 to 5, he says) to continue treatment.
I do realize that the future could be full of ups and downs, and am very aware of the possibility of relapse. But for now, I believe that difficult child is where he needs to be, and my feeling after having attended the FEP is one of great relief.
Okay, about the insurance and finances -- H and I met with the financial person right before we headed home. I had been communicating with her by email, and already had a good impression. That impression was confirmed by the meeting. Like everyone else there, she is intelligent, compassionate, and dedicated.
For our insurance, there are two levels of appeal. The first level can be initiated either by the patient (or in our case, by me, as difficult child's authorized representative) or by the treating facility. I had been thinking that I would do the Level 1 appeal, but after speaking with the financial person, I decided to let the facility go ahead and do that, and if their appeal is denied, then I will do Level 2, and write the kind of letter that lovemysons did.
I am actually somewhat optimistic about the chances of prevailing. In the Initial Adverse Determination letter, the insurance company spelled out their findings in support of their decision, including that difficult child "is not reportedly at risk of harm to self" and that "[t]here is no severe impairment in the member's . . . social support system such that the member is likely to use substances if not in 24-hour care." I think that the facility, with what they know now (difficult child is very forthcoming with them), should not have trouble making clear that those conclusions are flat-out wrong. The irony is that I wish that difficult child could manage with IOP rather than inpatient care -- it's not fun for us having difficult child be three hours away! -- but the fact is, he used drugs every single day, because all his friends did, some of them even more than difficult child. As to the risk of harm, from what I know now, I believe difficult child was at very real risk of physical harm, from a friend of his whom I believe is actually psychotic. (A sad case, as this friend is brilliant and very talented, but scarily and increasingly divorced from reality.) I am just 100% positive that if difficult child were at home, doing IOP, that he would do drugs every single night. And because of how he was earning money for drugs and because of his friend whom I believe is psychotic, I believe his life was actually in danger.
I don't want to give the impression that I am naive about the possibility of success on the insurance appeal, but I at least feel that it is worth the time and effort, and that it is not tilting at windmills.
Thank you all for your advice! I am so glad I decided to post here.