Insurance question

[tryingtobestrong]

Just wondering if anyone had this happen who had a child in rehab. My son decided he wanted to go into a treatment facility again so he made some calls as well as myself. We were told this place was in network with our insurance so since it was rated good and it was a less amount of money we agreed to send him there. The other one was over $23000 for 30 days.
They told me the amount I owed today and I was kind of taken back because we already had met our deductible. I questioned it and was told that every place is different and they take the "out of pocket maximum" for the in network instead of just the normal in network deductible of $2000 per person. (Our out of pocket max in network is $6350- which is supposed to be the deductible and any co-pays) I figured instead of arguing and being told my son isn't welcomed there I would just pay it.
Then tonight I get a paper to sign that is showing $31000.. I immediately called and was told that most insurances won't approve the patient to stay in the program for 30 days and that if they say he isn't approved for more than 10 days than I have to either pay the $1000 a day or remove him and put him in another program? I said when I called the insurance they told me that they will cover him as long as it is medically necessary and I told that to the rehab. I was told they will not lie to the insurance company if he is ready to leave before the 30 days.... Makes no sense since most places will tell you it takes longer than 30 days to get through to them and get a good start.
I am praying he is approved for the full stay.

 

[EarthIsHard]

Ugh, insurance in the US. Think twice and three times before you hopefully do not sign that paper. First of all, is your son over 18? Why do you have to sign the paper? OK, I know, I've been there. They know your son won't pay but you will. Most rehabs work out a cash price. A lot of rehabs work really hard and make the calls to keep your son in to get the help. If you sign, chances are those calls will not be made. Why would they? You already agreed to pay.
That is a lot of money. Not to be rude though chances are this might not be his last rehab.
Let them try and work it out without your signature. If all they really care about is the money, there are good rehabs that are free. Not as cushy, but oh well.
We paid some big bucks for our son's first rehab. Why? Because we wanted him there more than he wanted the help. We've been down many roads since then and I cannot say it helped more than the others, though the stay was really nice! Kind of makes me think we could have used some of it for the vacations we never took and instead put every bit of effort and money into something that just wasn't meant to stick at the time. There were great free ones. There were great insurance paid ones. For those, we made them guarantee the maximum that we'd have to pay out of pocket. We've had a great doctor offer a 'scholarship' for a program that is $50k/month. There are many programs out there. Not so nice if you have to move him but worth a thought.
Sorry, for carrying on. It's a lot of money. It's a long road. How does your son feel about being there?

 

[Orion123]

When you took out the insurance, you should have been told about all the conditions.

 

[AddictionSucks123]

I am in insurance middle person hell right now. I call the rehab billing center weekly to get updates and call the insurance company to make sure they are processing the claims for the days that he was in Rehab. From what I gathered from the Rehab facility upon intake, one person did say, since my son is unemployed and over 18 years old, the Rehab could try to get short term disability benefits, or work on a graded billing based on income. My insurance company did deny the request for my son to stay longer than 10 days. So, not sure what will happen with that.

The other thing you can do is complain to your State (if in the States), about the insurance company. You can go to the State insurance company website, and there should be a consumer complaint section where you can complain about your insurance company, if they refuse to cover the expenses for whatever dubious reasons. You do need to be exact and factual and they will contact you to interview and speak with you personally.