To laugh or cry- chatting with a top-rated psych hospital in Texas

[Parents! Get help here!]

 
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Joe says:
  Hello Bill . My name is Joe how can I help you?
Bill says:
  Can you tell me about your usual admission process- do you require a referral from patient's treating psychiatrist?
Joe says:
  People can self-refer. The process for admission is that we establish finances and then do a 30-45 minute phone interview with the patient.
Bill says:
  My understanding is that you do not work directly with insurance, but that you can assist clients in getting reimbursement? If that is correct, what payment do you require up front?
Joe says:
  We will file with insurance but insurance doesn't typically cover our services. We tell people up front to not count on insurance reimbursement since we don't see people getting reimbursement. As far as the payment up front that would depend on what program the patient was going to.
Joe says:
  Are you looking at HOPE, Compass, PIC (professionals in crisis), or ATP (adolescent treatment program)?
Joe says:
  Or our assessment program which is CPAS?
Bill says:
  ATP, my daughter is 17, BPD, and several other diagnoses, outpatient does not seem to be working for her
Joe says:
  Then the payment would be $23,800
Joe says:
  That would cover the first 2 weeks
Joe says:
  And we would collect the same amount every 2 weeks
Bill says:
  Do you know what specifically the reasons might be for denial of coverage? I am a federal employee, have BCBS, very good coverage generally.
Joe says:
  First and foremost, people don't meet medical necessity which is an insurance term. People will meet it when they do to acute care but we are subacute.
Joe says:
  And BCBS is notorious for not covering our services. Them and Humana.
Bill says:
  then I assume you also don't fall under their definition of "residential treatment center"?
Joe says:
  We do not. We are licensed as an inpatient psychiatric hospital.
Bill says:
  Ok, thanks for information, I will research my insurance documentation and be in touch.
Joe says:

[Big M]

 
Please wait. An operator will be with you shortly.
One moment please... .
We apologize for the delay. A representative will be with you shortly.
Joe says:
  Hello Bill . My name is Joe how can I help you?
Bill says:
  Can you tell me about your usual admission process- do you require a referral from patient's treating psychiatrist?
Joe says:
  People can self-refer. The process for admission is that we establish finances and then do a 30-45 minute phone interview with the patient.
Bill says:
  My understanding is that you do not work directly with insurance, but that you can assist clients in getting reimbursement? If that is correct, what payment do you require up front?
Joe says:
  We will file with insurance but insurance doesn't typically cover our services. We tell people up front to not count on insurance reimbursement since we don't see people getting reimbursement. As far as the payment up front that would depend on what program the patient was going to.
Joe says:
  Are you looking at HOPE, Compass, PIC (professionals in crisis), or ATP (adolescent treatment program)?
Joe says:
  Or our assessment program which is CPAS?
Bill says:
  ATP, my daughter is 17, BPD, and several other diagnoses, outpatient does not seem to be working for her
Joe says:
  Then the payment would be $23,800
Joe says:
  That would cover the first 2 weeks
Joe says:
  And we would collect the same amount every 2 weeks
Bill says:
  Do you know what specifically the reasons might be for denial of coverage? I am a federal employee, have BCBS, very good coverage generally.
Joe says:
  First and foremost, people don't meet medical necessity which is an insurance term. People will meet it when they do to acute care but we are subacute.
Joe says:
  And BCBS is notorious for not covering our services. Them and Humana.
Bill says:
  then I assume you also don't fall under their definition of "residential treatment center"?
Joe says:
  We do not. We are licensed as an inpatient psychiatric hospital.
Bill says:
  Ok, thanks for information, I will research my insurance documentation and be in touch.
Joe says:

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

[incadove]

Ouch. 

Should I say that again, maybe? 

I think laugh, then cry, then laugh, then buy maybe a good $400 of books and videos and an initial therapist appointment?  It does put those prices in perspective... .and I think you've got the irreverent DBT skill down!

Seriously, how is your dd?  How has she responded to the treatments you've tried so far, does anything work better or less well with her?

[LAHdedah]

I've had a similar experience when my son recently entered a drug rehab residential facility.  Blue Cross/Blue Shield's claim that they cover this is not worth the paper it is written on.  The facility recommends a 30 day stay for most patients but while my son was there we saw many, if not most, patients go home after only a week or two of therapy.  The reason was almost always because the insurance company had denied coverage.  In my son's case BCBS allowed him 4 days.  I figured the deduction which we are responsible for, would cover about 2 and a half days.  So... ., BCBS would only be responsible for and a day and a half!  Without ever seeing my son, they decided he would do just fine under outpatient care despite the recommendations of the staff and doctors.  We approved a month stay and are currently appealing BCBS's denial.

It says very plainly in the policy that they will cover such therapy but the truth is they routinely deny such claims.  They also will tell you that these claims are sent for approval or denial to an independent company that will review the claim for what they call "best practices".  What they don't tell you is this company (in our case "New Directions" is owned in part by BCBS and other similar insurance companies.  They don't tell you the whole racket is a self fulfilling prophecy - they say, "See, most patients only require a week or two of residential therapy before going home for outpatient therapy"  Never mind the fact that most patients go home because the company routinely denies residential therapy for anything beyond a week or two.

I will never again purchase insurance from BCBS despite the fact that my family has purchased insurance from them for over 2 decades.  I also will not purchase insurance from them or any other insurance company that pretends to cover residential treatment for mental health or drug rehab as I've learned from experience they'll gladly take your money but leave you, the customer, holding the bag.    

[Big M]

Incadove, , my daughter is on her 4th therapist, the latest for 8 months now, this one specializes in DBT, and nothing has worked, to be blunt, because my daughter does not work.  She wants to be better, but wants it bestowed on her like a gift, she either cannot or will not do the work.  Her therapist has wisely advised me not to waste a bunch of money on residential for her, she simply is not ready for it.