Intensive care vs residential treatment

[FauxLiz]

For those of you that have been following the debacle/saga of my abrupt discharge from River Oaks Treatment center I think I may have made a huge step forward in being able to return. I was speaking to an upper level manager and asked point blank: why is it if I were a drug addict or alcoholic and checked into a 30 day treatment center the insurance would not be contacting the facility every 3 days to see if the patient was stable enough for discharge you would let them complete the treatment program. So why is it that when a patient checks in for treatment in an inpatient trauma treatment program that is a 4-6 week program, the insurance company call every 2-3 days to check to see if they are stable to discharge, not if they have completed the program?

the Rep finally realized that mental health treatment should be equal no matter what the illness. I doubt if it will do any good but for a bit I felt like I got through to someone.

 

[Friday]

the insurance company call every 2-3 days to check to see if they are stable to discharge, not if they have completed the program?

Actually, a lot of insurance companies do this with drug & alcohol treatment as well. Even when the entire time period has been pre-authorised. And? Even if all the correct paperwork is resubmitted every 2-3 days, and every phone call caught (they have both verbal and written checks) they often deny services fairly randomly. At least once or twice per patient, per 30 day time period. At which point it takes 2 weeks for another pre-authorisation to go through. At which point? It’s 50/50 on whether or not they’ll preauthorise. Even though they had already done so. :banghead:

It’s a scam. Most people in inpatient treatment really need it. So they’ll private pay if at all possible, to stay in the program, counting on being reimbursed by the insurance company. But that takes 6-24 months IF they have the follow through to do so. Which means the thousands the insurance company is holding onto is collecting interest at worst, or doesn’t have to be paid out at all, at best (for them) if the patient gives up submitting appeal after appeal. And if they can’t private pay? The insurance company still gets to keep the money they had preauthorised -collecting interest- whilst all the paper-battles and authorisation happens all over again. Then IF they agree, again? It’s the same 2-3 day harassment of the facility, and randomly dropping the patient. :mad: it’s infuriating.

Wanna know what’s even worse? They do this with patients in the ICU, (and NICU & PICU) also. And every other area of medicine. ICU costs are often 50k-100k per day. There’s no way on earth patients can afford to private pay that. Speaking as a parent of a hospital kid who was millions in debt because our hospital wouldn’t refuse treatment to any child, no matter their ability to pay. The only reason my kid is alive is our hospital’s policy of flipping off insurance companies.

Gotta love the US healthcare system. :shifty:

 

[FauxLiz]

@Friday I had no idea just how bad our healthcare system is. I would have loved to consider staying private pay however I am just coming out of bankruptcy for medical bills not only am I trying to avoid ending up back there so soon and I can't file again for seven years so even if I wanted to I couldn't. Yeah our system sucks and I don't know what if anything I can do going forward.

 

[Sideways]

@FauxLiz - I think it’s awesome that you made this phone call. I don’t know what comes out of it for you in terms of getting the treatment you need. But you’ve advocated strongly on your own behalf, and that’s a pretty big deal. So congratulations, and I hope you get a positive outcome.

 

[FauxLiz]

@Sideways thanks for the encouragement (hard not to call you Ragdoll though). It seems strange but I have done a better job advocating for myself with insurance companies in the last month than ever before. I would like to think I have things under control but reading articles about work have sent me in a downward spiral since I got home so what I need now is the strength to point out why my employer has caused this nearly 2 year implosion and demand they buy my contract out in full.

 

[Deleted member 541]

It’s all about the money honey!!!! They want you out, actually they never wanted you in, in the first place. Insurance companies don’t care about the patient, they only care about their bottom line and if they are making money.

I hope that you can get this solved.....

 

[FauxLiz]

Not been one of my better weeks, I get that my t wasn't expecting be back this week but he agreed two schedule two appointments and then has rescheduled both. I know it doesn't mean anything but it hurts and when it hurts that downward spiral begins and is so hard to stop.

 

[Deleted member 541]

Self care is what you need to do to stop the spiral. So, he rescheduled. It’s ok, it isn’t the end of the world, you have all of us and all of us will help to pull you through this.

 

[FauxLiz]

Thank you. It is a struggle to return to my home life and feel like they don’t need or have room for me in their lives anymore it’s hard to not turn that into they don’t need or want me permanently

 

[Deleted member 541]

Is this how you feel, or is it really the way it is????

 

[FauxLiz]

That is where I struggle at times like this to differentiate the two right now Ivan tell this is just the depression talking I just have keep reminding myself of that

 

[Deleted member 541]

Yes, it is the depression talking. It has a mouth that just doesn’t shut up either. Keep busy, keep doing healthy coping skills, and know that we’re here, and it will get better. It’s the roller coaster of emotions, You’re on it now, and maybe next week, I’ll be riding that bitch!!!!!