Yesterdaysnumb

Okay,

For one thing. The hospital rehab facility here in Ohio denied my husband (initially) for his substance abuse and alchol addiction. They said "there are no withdrawl symptoms for cocaine, PCP, or marijuana. Only alcohol. So unless he shows extreme withdrawl from alcohol, he can't go to rehab." I thought that was ridiculous. But, we faked his addiction so over the top (after he was denied once) that they had to let him in inpatient. So here's the diliema now. There saying that the insurance only covers 3 days not 28 days for the program. Have you guys ever heard of this?

Has it ever been this hard for any of you or your loved ones to get help?

bigredme

I ended up having to declare bankruptcy because my insurance denied my inpatient stay. they said my Dr. did not get proper approvals to put me in there so after HE fought for 2 years to get my stayed paid...I got stuck with the bill. A lot of insurance companies won't cover inpatient. You have to jump through all sorts of hoops to get it even when the policy says it covered. Check out whether or not it's covered first and then start fighting. His Dr. can help. good luck to both of you honey. i hope he can get the help he needs
bigredjen

serenityqueen

Unfortunately, yes. Insurance companies have made cuts in so many areas and one of them is inpatient treatment for addicts and alcoholics. Most only cover detox anymore.

You mentioned you live in Ohio. I live in Dayton, I'm not sure what part of the state you live in but there are many, many other programs available. Though they may not be a 28 day inpatient program,so many others are available.

I assume you meant that he exaggerated his symptoms when you said "we faked his addiction so over the top that they had to let him in inpatient." I don't think this is such a good idea to continue doing this. One of the most important parts of Recovery is honesty. Also, he will not get the help that he needs without complete honesty. Many of us addicts/alcoholics think we know what's best for us. It's usually not.

If you'd like to send me a PM, I'd be happy to share with you places to turn to for help here in Ohio.

God Bless,
Judy

Yesterdaysnumb

Oh no. We did fake it. Instead of him having two - three beers a day on an average plus maybe a pint of wine. We said that he HAD to have at least 4-5 beers a day on an average and about a fifth of liquor. Not to mention the other drugs. (but we didn't fake those)

At first, I felt bad. But, I truly believe that he can't do it by himself and rehab is something that we both feel would do him major good. So I did feel bad about being dishonest. (he even drank before he went in to seem as though he were intoxicated) But, I see this as a cry or a freaking SCREAM for help. It's so sad that people feel as though they have to resort to extremeties to just get help. And I'm one of those people....

Chino

Our insurance is BCBS and they'll pay for 21 days rehab not the standard 28. I expect to see them further reduce it to 14 before they phase it out completely.

The last time my daughter detoxed, she called the local hospital first and they said she had to be in active withdrawals for admittance according to our insurance. I didn't believe that because other hospitals didn't say that. I called BCBS and they said it would be better for her to be actively using so high levels of the drug indicated abuse in the drug screen.

So there we sat, discussing the pros and cons of shooting up again or not to suit a hospital and insurance. We were both shaking our heads and talking about how screwed up it all is. That was a surreal moment.

Drug addiction, specifically opiates and benzos, has quickly become a plague in my community and it's the same for others. It's going to get worse before it gets better and our health care professionals aren't prepared for that.

Yesterdaysnumb

That's just crazy... It shouldn't be this way! So what'd you do? Did she or not? And if she didn't... did she ever get the help she needed?

justanothrdrunk

I've been working at an insurance company for 12 years. Here's the deal...

Health plans (with regard to treatment for substance abuse) can cover nothing at all to everything (unlimited) at 100% and everything in between. There are no federal regulations that require a plan to cover this. Some states do regulate treatment, but not all plans are subject to state regs. Odds are that if your coverage is through an employer and that employer is larger, they are not subject to any state regs. And the rules are different still if you have an individual plan (where you just buy a plan on your own like car insurance).

Some plans have dollar limits, day limits... and those limits can be per year or per lifetime. Plans can limit how many treatments (no limits on dollars or days, but perhaps allowing only one admission per lifetime). They can also combine any of these limits together - limits on days, dollars, AND the number of admissions.

Some only cover detox. Some don't cover the detox but will cover treatment... It's really a mixed bag.

Many states have public programs available for those without insurance or the scratch to pay for treatment. In Minnesota, there's something called Rule-25 where you can apply for the state to pay for your treatment. You don't necessarily have to be eligible for any other public assistance to qualify for Rule-25. You may want to check with some local agencies to see about assistance.

I'm also aware that some rehab facilities offer scholarship type programs for those in need. You could also check around to see if you can find a facility that would allow you to self-pay at a discount or would be free of charge.

justanothrdrunk

Oh, and, be very cautious about, um... what you allegedly did there.

Insurance fraud includes a broad range of things. And it's a federal offense - felony. Insurance companies that catch wind of anything funny can be really aggressive in persuing legal action.

laurie6781

Please go check with your local Salvation Army. If they do not have a program in your city, they can probably get him into one in another city.

Salvation Army is FREE and has an EXCELLENT program for those that are READY and WILLING to go to any lengths.

J M H O

Love and hugs,

ZombieWife

What is wrong with our country and our healthcare that allows these people to fall through the cracks like this? :wtf2

jerect

I have BCBS of Georgia and my handbook is very vague about what they cover as far as Chemical Dependancy. From what I can gather, treatment has to be prescribed by a Dr., so does this mean my AH coulden't check himself into rehab on his own free will? For all I know it could be common practice for the DR to prescribe treatment.

However my insurance does cover A Chemical Dependancy Treatment Center, inpatiant room and board and outpatiant treatment. How many visits and what the length of time that someone can stay in rehab is not mentioned. It doesn't mention anything about detox but it does say that they wont cover methadone when used for treatment of drug abuse.

My AH is not at the point where he needs to go to rehab, or at least not yet but I do want to know my options and the financial aspects of it just to be on top of things.

Insurance Companies frustrate me. I pay mega bucks every month to have it and then there are all these stipulations about what they will cover and what they will not cover.

Ann

I agree with Laurie. The Salvation Army programs are very good and they are free. Most are 90 days which is better than 28 days and more effective.

In Canada, it's all covered under our health care and costs nothing. I think that is how it should be everywhere.

Good luck, my prayers go out that you find something without having to resort to tricks and dishonesty.

Hugs

greeteachday

I truly hate that many insurance companies value the bottom line more than life (and believe me, as a consumer advocate, I see it too much in my state) The first time my daughter finally agreed to treatment, we drove through a blizzard because the treatment center told us to come while she was going through withdrawal (heroin) An hour drive took 3 hours and heroin wtihdrawal isn't pretty. Even then, BC said they would not cover in patient detox because she hadn't tried outpatient detox yet and there was a place that offered it 1 1/2 hours away. I insisted she be admitted and I would battle later....It was the first of several battles, ending only with her tragic death and is one of the resentments I have difficulty letting go of .

I agree that the Salvation Army is a good idea. I don't know how much Ohio regulates health care coverage or whether you have a small group, large group or individual plan. But Ohio has an active department of insurance and if anyone could help you with some answers at least to what you are entitled to, they can. (please don't mention faking the symptoms or severity though.)

Some day, I pray this will change and like our neighbor's to the north, medical treatment won't be conditioned on how much money one has.

rozied

Oh Ann I do agree with you (though to a point.) I don't know if I 'd want universal health care cuz I live in the USA and I don't know enough about it, but our Government should have free programs in place to help drug addicted people. From short term programs to residential programs where people can stay for up to a year so they can get the help & support they need. Drug Abuse has reached epidemic proportions & I hope this problem won't continue to be ignored like the AIDS epidemic was for so long.

laurie6781

If our government would take even HALF of the money alloted to the DEA and put it into good residential programs for the alkies and addicts, we wouldn't need the DEA. There would be no profit for the drug dealers.

J M H O

Love and hugs,

justanothrdrunk

You're correct about this. The state you're in may have different laws about a rehab center. But basically, when you're admitted, it's a doctor from that facility that signs/recommends that admission. So even if your AH checks himself in, he's probably good to go.

If there's no mention of any limits, odds are there are no limits. Any plan with limits will spell it out loud and clear.

Detox - again unless explicitily excluded - is generally going to be covered. This would be medical detox with medical supervision and including whatever medical withdrawal protocol is needed to keep the patient safe.

Find the section in your book called General Exclusions or Exclusions and Limitations. Read that section throughly. If it's not called out in that section, it's often covered.

Unfortunately, this is necessary. Every time legislators make a new law, there needs to be new stipulations. Fraud/abuse is rampant. When I was a claims examiner I saw claims for kayaks and karate lessons. The justification was for physical therapy. You would be really surprised what folks try to get away with. Many feel entitled. They argue that, because they pay in so much money, the company should pay for anything and everything under the sun that could be construed as therapeutic. Hot tubs, vacations (seriously), tennis lessons, etc...