Frustrated with insurance carrier ...
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
Frustrated with insurance carrier ...
I am so frustrated with this right now!!! Since Tuesday we have been trying to get AH in a treatment center out of our hometown of Jax fl. We were also adv that it is best that the A not be treated in the same city... specially since the one treatment center they keep tying to put him in is 3 miles down the road!!!
They do not care that we will have to travel 4 or 5 hours to the next treatment center, but one 1 hour away can not be covered because it is 15 minutes outside our service area and we do not have OON bene even though this center is a covered center for the insurance.
Then to be told I am trying to hard.. that since my husband is not making ALL the calls, maybe he does not want it bad enough!! HELLO!!! He is telling me daily he wants to go in, just not so close to home. You would think that these ppl in the "medical profession" would understand that !!!
What ever happened for the good of the patient?! I used to work in the medical insurance , and we did all we could for quality care for a person. You would think that is what the insurance would want also.
Then the admissions office at one facilty says, you are working on this longer then the isurance would even cover for a visits, just basically are you sure he would not be better to go to an ER and be admitted for detox?!
HELLO.. is it not better to get them into a treatment facility that can help start the steps again,., and work with them? not just a hospital that will give them more drugs to detox from drugs?!
I am so frustrated. MY AH is frustrated,after talking to the insurance carrier and telling them even that he wants to go away from home, that a treatment center to close would not be good for him, our PCP has told them that even.
They will cover another one hours away, but not one an hour away!! This is so frustrating.. and to appeal will take a minimal of 15 days.. if esculated up to 72 hours... but only during the week.
And not since it is friday evening,, no one will take him since we have private insurance and they can not verify it till Monday. I want to scream and cry and just punch something.. I am so frustrated..
But woosaaa... AH says if we can find one this weekend out of our area but that is approved he will go there, but we need to do some looking. We do not want one that will not be good,and I know that all treatment centers are not the same..
ok... calm.. breathe.. :-) better now. Thanks for the vent!!!
They do not care that we will have to travel 4 or 5 hours to the next treatment center, but one 1 hour away can not be covered because it is 15 minutes outside our service area and we do not have OON bene even though this center is a covered center for the insurance.
Then to be told I am trying to hard.. that since my husband is not making ALL the calls, maybe he does not want it bad enough!! HELLO!!! He is telling me daily he wants to go in, just not so close to home. You would think that these ppl in the "medical profession" would understand that !!!
What ever happened for the good of the patient?! I used to work in the medical insurance , and we did all we could for quality care for a person. You would think that is what the insurance would want also.
Then the admissions office at one facilty says, you are working on this longer then the isurance would even cover for a visits, just basically are you sure he would not be better to go to an ER and be admitted for detox?!
HELLO.. is it not better to get them into a treatment facility that can help start the steps again,., and work with them? not just a hospital that will give them more drugs to detox from drugs?!
I am so frustrated. MY AH is frustrated,after talking to the insurance carrier and telling them even that he wants to go away from home, that a treatment center to close would not be good for him, our PCP has told them that even.
They will cover another one hours away, but not one an hour away!! This is so frustrating.. and to appeal will take a minimal of 15 days.. if esculated up to 72 hours... but only during the week.
And not since it is friday evening,, no one will take him since we have private insurance and they can not verify it till Monday. I want to scream and cry and just punch something.. I am so frustrated..
But woosaaa... AH says if we can find one this weekend out of our area but that is approved he will go there, but we need to do some looking. We do not want one that will not be good,and I know that all treatment centers are not the same..
ok... calm.. breathe.. :-) better now. Thanks for the vent!!!
Member
Join Date: Feb 2008
Location: Chicago area
Posts: 4,269
He's telling you he wants to ......but his lack of action, on his own behalf, says something quite different.
Does he have a disability that requires someone else to do, what he otherwise would do, to seek treatment?
Does he have a disability that requires someone else to do, what he otherwise would do, to seek treatment?
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
cynical one No.. this is not his first time.. this will be his 4th rehab and his 6th relapse since we have been married. we are used to going round and round with the insurance carriers. Even when I worked for a medical insurance company.
Thankfully, even though he is not yet in somewhere, we are trying to find a decent place in FL for him to go to, he is talking to NA buddies. We are currently working on a plan together to see what we can do and where there are dual dx centers. LOL I almost wish I was naive and that this was not the first rehab.
outtolunch: what lack of action do you think that he is not doing? I am curious? I gave an overview of our last four days fighting the insurance carrier. Because I am giving MY frustrations and not my AH, please do not think that he is not taking action.
Thankfully, even though he is not yet in somewhere, we are trying to find a decent place in FL for him to go to, he is talking to NA buddies. We are currently working on a plan together to see what we can do and where there are dual dx centers. LOL I almost wish I was naive and that this was not the first rehab.
outtolunch: what lack of action do you think that he is not doing? I am curious? I gave an overview of our last four days fighting the insurance carrier. Because I am giving MY frustrations and not my AH, please do not think that he is not taking action.
Forum Leader
Join Date: Dec 2004
Location: The Burgh
Posts: 1,991
(((connecian)))
I ask this out of caring...not malice...
While everyone is arguing and delaying, is he still using? Because I think if I were the addict, that would work out fine for me. There's a big difference between "saying" you are going...and going.
The treatment facility is most often only as good as the patient.
You can sneak things in anywhere.
My son attended one that was a bit run down, and in an area I would NEVER venture alone...but they talked and he listened. In fact, the "club med" type facility closer to us would have probably been not as effective. He needed to know he was just like the others, an addict.
With that said, I know insurance issues can be maddening.
I hope something works out for him soon.
(((Hugs)))
I ask this out of caring...not malice...
While everyone is arguing and delaying, is he still using? Because I think if I were the addict, that would work out fine for me. There's a big difference between "saying" you are going...and going.
The treatment facility is most often only as good as the patient.
You can sneak things in anywhere.
My son attended one that was a bit run down, and in an area I would NEVER venture alone...but they talked and he listened. In fact, the "club med" type facility closer to us would have probably been not as effective. He needed to know he was just like the others, an addict.
With that said, I know insurance issues can be maddening.
I hope something works out for him soon.
(((Hugs)))
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
Originally Posted by cece1960 
(((connecian)))
I ask this out of caring...not malice...
While everyone is arguing and delaying, is he still using? Because I think if I were the addict, that would work out fine for me. There's a big difference between "saying" you are going...and going.
The treatment facility is most often only as good as the patient.
You can sneak things in anywhere.
My son attended one that was a bit run down, and in an area I would NEVER venture alone...but they talked and he listened. In fact, the "club med" type facility closer to us would have probably been not as effective. He needed to know he was just like the others, an addict.
With that said, I know insurance issues can be maddening.
I hope something works out for him soon.
(((Hugs)))
I ask this out of caring...not malice...
While everyone is arguing and delaying, is he still using? Because I think if I were the addict, that would work out fine for me. There's a big difference between "saying" you are going...and going.
The treatment facility is most often only as good as the patient.
You can sneak things in anywhere.
My son attended one that was a bit run down, and in an area I would NEVER venture alone...but they talked and he listened. In fact, the "club med" type facility closer to us would have probably been not as effective. He needed to know he was just like the others, an addict.
With that said, I know insurance issues can be maddening.
I hope something works out for him soon.
(((Hugs)))
He is still on two of the drugs, both prescribed, and was told to not stop till he got into treatment due to the withdrawls that he would face.
It is frustrating that we are not asking to go to Club Med, just a place where they will listen, and one that came recommend by our PCP. He has never been to a Club Med. The ones close to us are not good, they push suboxone and subtex, things he does not want to be on, just exchanging one drug for another.
Actually.. the attacks on me by some ppl are one of the reasons I usually do not post, but was encouraged to by someone tonight to let out my frustrations. It is so funny, so many ppl think that the addict alone has to do ALL the work. Well, I have a background in medical insurance and know that there are appeals and steps to get approval for OON facilities. So my husband asked for my help to get into rehab,. That does not mean that he is not working to get into rehab also.
This post started out as a way to vent on MY frustrations with the insurance carrier, not on what my AH is or is not doing to get into rehab treatment. It was about MY frustrations at being talked down to while trying to get my AH in a facilty that we know is not a "club med" but is a highly recommend facility by medical dr.
Seems funny, if I was asking for help on investing, because someone had more experience and I let them do the talking for me to an investment firm, while trying to know what to say and who to ask for.. it would be a learning experience.
As for his lapses, I support his effort EVERY TIME to try and get clean. That is why each time he has gone in, we learn of peramiters we need to set up. I laugh at so many ppl who are negative that since we have been married 10years think this is too much.
Well, I feel that GOD is with me every step I take, as is my family and my parish and friends. I have learned that it is the addicts responiblty to try to remain abstinant and active in their recovery program, but that they need a foundation of support as well. It is only my job to understand how neccessary this is to him, if I want to be with him.
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
Originally Posted by cynical one
Attacks...you have got to be kidding me.
And, the addict MUST do all the work. Keep doing the same, and you will get more of the same...but that obviously fills a need in you, now doesn't it?
And, the addict MUST do all the work. Keep doing the same, and you will get more of the same...but that obviously fills a need in you, now doesn't it?
Since this was started as a post about ME not the A, and my frustrations getting the runaround from the insurance carriers, and the misinformation and the runaround our dr also got I have only rcvd responses related to the A,and what he is or is not doing.
More of the same? This is the first time I have fought to get him into a treatment center, one he requested that has good program,and was recommended. Previously, he wants to go, a call is made by the dr and he was in treatment.
I am still Frustrated that the insurance gave me, and him, the runaround for several days, telling us to do one thing, we follow their instuctions and then get told that was wrong.
I am still frustrated, that a treatment admin office personnel tried to tell me clinical information re: care, since she was not a counsler.
I am frustrated that after several days with insurance carrier with our family dr and us saying that the A wants to go to a facilty to get off what he is on and not trade one drug for another, they seem to want to put him into a facility that is known for giving suboxone and subtex, isntead of one that will help him get the treatment he needs.
Administrator
Join Date: Mar 2006
Location: a better place
Posts: 4,047
Insurance can indeed be maddening; I certainly understand a need to vent. The insurance carrier refused to cover inpatient detox for my daughter while she was in the midst of heroin withdrawal and we had transported her in the middle of a blizzard to a place she contacted when she finally admitted she needed more help than she could give herself. (To me, after months of denial and spiralling out of control, admission that she needed help and agreement to treatment were huge steps and it blew my mind that instead of the hurdle being her overcoming her denial; it was battling insurance) They told her to try "outpatient detox" at a hospital on the other side of the state...yes in the middle of a blizzard. I too, jumped in at that point and said you kick her out in the snow now and I will take this to every media and every legislator possible. Headlines of big insurance company denies 19 year old's cry for help wouldn't be too appealing.
Ironically, after the many attempts with detox and outpatient, it took travel to Florida (your state) a good 1,500 miles from us, for the insurer to provide coverage for inpatient at all.
I do hope your husband finds a viable solution soon and that you will have a chance to get off the roller coaster and restore some sense of sanity and balance for you!
Ironically, after the many attempts with detox and outpatient, it took travel to Florida (your state) a good 1,500 miles from us, for the insurer to provide coverage for inpatient at all.
I do hope your husband finds a viable solution soon and that you will have a chance to get off the roller coaster and restore some sense of sanity and balance for you!
Attitude of Gratitude
Join Date: Sep 2007
Location: Dayton, Ohio
Posts: 2,305
I can emphasize with what you're going through with the insurance company. I haven't had any insurance myself in many years up until recently, but I have dealt with my Mom's, Medicare and she has Medicaid to back up what Medicare doesn't cover. Even getting the right person on the phone to talk to is like an obstacle course . . . and this is after listening to a half an hour of the absolute worst elevator music ever made! lol
Although I do not agree with some of the things that were said on here, I agree with the replies about it doesn't matter where your H goes, it's what HE puts into it. Over the 25 years I went in and out of treatment centers, detox, in patient, out patient, . . . I had been in a variety of places. My ex Mother and Father in law paid for me to go into treatment not long after their Son and I got married. Our insurance company through his work would "only" pay for inpatient at a local hospital, which I was more than happy to go to. (I didn't care where I went, just get me in!) But his Parents had heard of a few people who went there and relapsed so they saw this as a sign of the treatment center not being a good one. Since they were paying and I wanted help desperately, I went to this treatment center they had picked out for me. It was a beautiful facility, everyone had a private room that looked like something out of Better Homes and Gardens with all the enemities, the meals were excellent with many, many choices, there was a rec room that had nearly everything imaginable. The only thing missing was there really wasn't any treatment! It seemed like a 30 day vacation and the only thing that was missing was my drugs and a bar stocked with alcohol.
A few years later, I put myself into a long term treatment center ( 9 - 12 month program) that was state and federally funded. If someone didn't have any insurance or money, it didn't matter. Sure there was a long waiting list, but I stuck it out. The building was in one of the worst areas of town, it looked like it should have been condemned (which it was a few years later!) the rooms were no bigger than a closet that were shared with another patient. . . two twin beds, two dressers and two lamps, that was about it. The food was comparable to cafeteria food when I was in elementary school, you ate what they had or you didn't eat, it was that simple. But I have to tell you, I got so much out of this Program. To this day, I practice many of these principals in my Recovery.And in July of 2005 when I surrendered, with the strong recommendation of the Addiction Specialist Dr. who treated me yet again in detox, I started in a MMT IOP Program which is in the worst end of town, a neighborhood of nothing but dope houses. This building is run down that the facility is trying to relocate. But, I have gotten so much out of this place. I have no doubt in my mind that if I hadn't started there the day after I got out of detox, I would not only have relapsed very soon, I would more than likely be dead today.
I personally don't understand the concept of not going to a treatment center close to home. IMO, it shouldn't matter where the place is located, it's what you put into your Recovery that determines what you get out of it.
Finally, IMO, from what you have shared on here and with me in PM's, there is absolutely nothing wrong with you dealing with the insurance company for the simple fact that you worked in the field and this can be a plus. I look at it like this, if I needed to find out what kind of part I needed for my car and a mechanic offered to call around and ask, I'd glady let him/her do that for me. But once I found out what I needed, then I take it from there, call around to find out who has that carborator for example. You shared that your H is making all the calls and doing all the work on finding a treatment center, right? If he were sitting around playing Play Station while you were doing everything, then it would be a different story.
You mentioned your H is still using two of the drugs he's trying to get off of, Methadone and Xanax. Until he goes into detox/treatment, it's not advisable that he just stop either one of these two drugs without being under medical supervision. . . especially the Xanax. Withdrawl from Xanax can be extremely serious, even deadly if not under medical supervision. And going cold turkey off Methadone is, from what I have been told, a pure, living hell. Now, if he's using and getting high, then there's a problem. As someone who is on Methadone, if someone is taking the correct dose, there is no high. I won't get into anymore regarding Methadone because that's an entirely different topic right there.
As much as it may seem that some people are attacking you, I honestly don't think that is their intentions. There are so many people on here who lived and enabled with an addict/alcoholic of their own and they are only trying to hopefully prevent you from making the mistakes they did. At least I would hope this is their intentions.
Finally (yes, I'm almost done here! lol) I would like to add that while there are addicts who truly don't want help, there are some of us who it may take several attempts before finally "getting it." I am one of those addicts who it took many,many times of detox, treatment, in and out of AA and NA before I finally can say that I now have 3 years and 10 & 1/2 months Happy, Joyous & Free! I thank God that my own Family didn't give up on me.
God Bless,
Judy
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
Good Morning~
Yes SQ you are corrent - I have been dealing with the insurance carrier. My AH has been making the calls to the dr and the treatment center after I get off the phone with the insurance carriers ( both medical and mental).
It was a strong suggestion to us that he not go locally for a few reasons:
1. The center closest to us; out pcp does not respect because the treating dr at the facilty uses drugs to get off drugs. MY AH has been on suboxone before, and had a difficult time getting off it. H has made it clear to our pcp that he does not want to come off methadone and xanax just to go to another "blocker" for opiates.
2. the other center that is covered is worse than the one above. I know we are taking the word of our pcp~ and ppl we know that work in the medical fields, but since neither my husband and I do not work in these facilites, we are trying to take the words of medical experts - not other treatment centers.
3. Also, the PCP told my H that he would like him to go to a treatment center that is out of town, where family can not readily visit. I have already told my AH that wherever he goes, I will visit twice. Once per each weekend he would be there if they allow visits. I do know my mother in law would try to visit as often as possible if he was local.
also, if I had not talked to ppl in the medical field re: the local facilites, and was not just taking my AH opinion, I would not be this determined about getting into a different center. He is not getting high right now, thankfully~ bust does want a treatment center.
One day, I pray my AH will be clean and live a wonderful life. I made a vow when I got married, for better or for worse. That includes going thru times like this with him, so be it. I can be part of the foundation that he stands on - once he gets clean. Not to do the work for him in his recovery, but to know thatonce he is clean ~ the hope that we will have better lives.
I do have to say, funny though, that this time we are in a different part of our marriage, and we are closer than ever before. He has beensharing with me for weeks about thoughts, and I have just let him talk, knowing he was using, but knowing I can not make him do anything. So when he said he wanted to go back in , that he needed to go back in, I felt a blessing that he said that. It was not me telling him, but himself and others he was talking to from NA.
I also thank those that understand the frustrations of working with insurance. They would rather us go 300 - 800 miles away, instead of a facilty that is just 88 miles away. It is a facility they work with, and cover too, just not for my immediate network. That is what was frustrating. I was told if the pcp showed medical neccessity with reason on why he needs to go there, the MD director would review the file w/in 24 hours. That was on Wednesday and Thursday. My AH and our pcp tried dillegently to get this done. I had all my notes on who I spoke with and what they told me. Only to have the facility call and be told.. nope it would not be going to review, not even a consideration. I felt frustrated after being told several times this was the case.
AH and I talked about this on Friday, and are resigned to find another facilty that they will cover instate.. even if it means going 300 miles away. I just am mad after jumping thru hoops and my dr office trying and H trying, that we kept hitting a wall - and somewhere along the lines, someone kept telling us it was possible, and now we do not know if the facility is lying to the insurance carrier.
So we are checking dual dx treatment centers inother parts of the state now. fingers crossed.. we will find somewhere where the insurance will take so he can begin a treatment program on Monday at the latest.
:ghug3
Yes SQ you are corrent - I have been dealing with the insurance carrier. My AH has been making the calls to the dr and the treatment center after I get off the phone with the insurance carriers ( both medical and mental).
It was a strong suggestion to us that he not go locally for a few reasons:
1. The center closest to us; out pcp does not respect because the treating dr at the facilty uses drugs to get off drugs. MY AH has been on suboxone before, and had a difficult time getting off it. H has made it clear to our pcp that he does not want to come off methadone and xanax just to go to another "blocker" for opiates.
2. the other center that is covered is worse than the one above. I know we are taking the word of our pcp~ and ppl we know that work in the medical fields, but since neither my husband and I do not work in these facilites, we are trying to take the words of medical experts - not other treatment centers.
3. Also, the PCP told my H that he would like him to go to a treatment center that is out of town, where family can not readily visit. I have already told my AH that wherever he goes, I will visit twice. Once per each weekend he would be there if they allow visits. I do know my mother in law would try to visit as often as possible if he was local.
also, if I had not talked to ppl in the medical field re: the local facilites, and was not just taking my AH opinion, I would not be this determined about getting into a different center. He is not getting high right now, thankfully~ bust does want a treatment center.
One day, I pray my AH will be clean and live a wonderful life. I made a vow when I got married, for better or for worse. That includes going thru times like this with him, so be it. I can be part of the foundation that he stands on - once he gets clean. Not to do the work for him in his recovery, but to know thatonce he is clean ~ the hope that we will have better lives.
I do have to say, funny though, that this time we are in a different part of our marriage, and we are closer than ever before. He has beensharing with me for weeks about thoughts, and I have just let him talk, knowing he was using, but knowing I can not make him do anything. So when he said he wanted to go back in , that he needed to go back in, I felt a blessing that he said that. It was not me telling him, but himself and others he was talking to from NA.
I also thank those that understand the frustrations of working with insurance. They would rather us go 300 - 800 miles away, instead of a facilty that is just 88 miles away. It is a facility they work with, and cover too, just not for my immediate network. That is what was frustrating. I was told if the pcp showed medical neccessity with reason on why he needs to go there, the MD director would review the file w/in 24 hours. That was on Wednesday and Thursday. My AH and our pcp tried dillegently to get this done. I had all my notes on who I spoke with and what they told me. Only to have the facility call and be told.. nope it would not be going to review, not even a consideration. I felt frustrated after being told several times this was the case.
AH and I talked about this on Friday, and are resigned to find another facilty that they will cover instate.. even if it means going 300 miles away. I just am mad after jumping thru hoops and my dr office trying and H trying, that we kept hitting a wall - and somewhere along the lines, someone kept telling us it was possible, and now we do not know if the facility is lying to the insurance carrier.
So we are checking dual dx treatment centers inother parts of the state now. fingers crossed.. we will find somewhere where the insurance will take so he can begin a treatment program on Monday at the latest.
:ghug3
Member
Join Date: Oct 2008
Location: Marietta, GA
Posts: 1,453
To show the the other side of this - first off be thankful that your insurance company will cover anything - believe me it could be worse - mine covers nothing at all as far as rehab - not even outpatient. Secondly the further away he is the better it will be. even an hour away is pretty close if he decides to leave - too close to resources that can come pick him up. so if i were you be thankful there is some coverage - ask them exactly what locations they will cover and then let him go no matter how far away it is. If its too far for you to visit then its just too far - he doesnt need visits to get better - sometimes in fact its better for them to spend some time alone to get better - you're visitations will have no impact on whether or not he embraces recovery.
Love is magical.
Thread Starter
Join Date: Jul 2004
Location: Florida
Posts: 21
Originally Posted by winnie12
To show the the other side of this - first off be thankful that your insurance company will cover anything - believe me it could be worse - mine covers nothing at all as far as rehab - not even outpatient. Secondly the further away he is the better it will be. even an hour away is pretty close if he decides to leave - too close to resources that can come pick him up. so if i were you be thankful there is some coverage - ask them exactly what locations they will cover and then let him go no matter how far away it is. If its too far for you to visit then its just too far - he doesnt need visits to get better - sometimes in fact its better for them to spend some time alone to get better - you're visitations will have no impact on whether or not he embraces recovery.
We are thankful for our coverage. We agree far away is better ~ we have been told that by medical personnel!! Thank you and the others that are understanding in this point !!!!! :-)
Thank you for those that are understanding in the frustrations of the insurance !!!
:ghug3
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