Insurance Coverage and RTC

[Xegxorina]

Has anyone had any luck with their insurance company assisting with/ covering  payment for a RTC? Specifically my insurance plan has unlimited residential coverage with approved providers- Keystone East (HMO from BCBS.) However, I've heard that insurances stop paying even when they say unlimited because they demand constant re-evaluations of necessity that RTC cannot provide. Of the 3 facilities in network (Devereux Mapleton, Kidspeace and Foundations Doylestown,) only Devereux seems to have experience with BPD, especially at their Massachusetts' facility, which is not in network.

Since research seems to show that d15 will be more likely to continue in the revolving door of expensive acute care facilities without the right tx, I have proposed to my insurance co that they make an accomadation to go out of network or reimburse upfront for private pay. Has anyone else tried this successfully or unsuccessfully?

I am also working to get her medical assistance and am looking into pursuing school district funding, but she is in an acute tx center 2000 miles away after trying a private pay program that could not handle her and need help now.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[lbjnltx]

Hello Xeg, 

Welcome to the board!

I have not had any luck getting insurance to pay for RTC.  We ended up doing self pay from start to finish as our policy only covered 2 weeks inpatient care and by the time we met the out of network deductible the 2 weeks was up... . catch 22.

Many more people have had success going through the school system to get funding through an IEP.  This can be a long detailed process that requires patience, and co ordination with her psychiatrist, therapist, school district, etc... .

The IEP route, if successful will open more options for placement and will at least cover the educational portion.  Perhaps the insurance company will pick up the remaining treatment portion.

I noticed in your other thread that you are wanting placement close to home.  That would be most preferable and not always the best choice for treatment.  A highly involved family is one of the keys to successful treatment.

Sincerely

lbjnltx

[crazedncrazymom]

If you live in PA, your daughter will qualify for medical assistance due to her diagnosis.  It can take some effort, but if you have enough supporting reasons medical assistance will pay for rtf in full.  Medical Assistance will give you far greater choices and also offer wraparound programs and family based services, which you must use before they will cover rtf.

I don't have any experience with foundations or devereaux (seem to recall hearing not great things about them).  Stay FAR away from Kidspeace.  I have spoken with many professionals in the area and Kidspeace tends to just be a holding place. My daughter is currently in Hoffman Homes down in Gettysburg.  Her doctor is great and has a real understanding of BPD.  The house staff is good and they provide an accountability system.  Their therapies (horsemanship, horticulture, art and pet therapy) are really great.  Her therapist is unofficially practicing DBT.  DD16 is making great progress there.

Good luck!

crazed