Re: Just when things were looking up!!

[Guest guest]

Would your school district pay for this?

Just when things were looking up!!

Okay, first the good news........my son is up to 118 lbs. now and is still

eating well, so that is awesome news. He's continuing to make progress as far as

participating in more activities and programming at 's and is turning some

corners in other areas.

Now for the bad news.......got a call from 's today that Blue Cross is

denying further coverage for my son to stay there. I can not begin to tell you

how devastated I was to get that call! There is NO WAY he is anywhere remotely

close to being able to be discharged and there are so many compelling reasons

why that I can not believe the Blue Cross doctor would argue this.

They're saying he's ready to go down to PHP (Partial hospitalization) but due to

his bathroom issues and other factors, there is no way a PHP would even take

him, not to mention the fact that that type of upheaval for him at this juncture

would completely do him in and send him right back to square one, or even worse.

I am so beyond livid about this I don't even know what to say. We have an

" expedited appeal, " which is a 24 hour turnaround, so we'll know by tomorrow

whether they overturn it, but even if they do approve him, it's only for 7 days

at a time. Once they put up a denial, then moving forward they'll do everything

they can to push the patient out on a weekly basis,

Bottom line, I will live in a tent if that's what it will take to keep my son at

's until he's ready to be discharged. Insurance companies are just flat out

disgusting how they could put a child's life at risk like this is completely

beyond me!!

If anyone might have suggestions on dealing with this type of situation with

insurance companies, please let me know.

Please cross your fingers, and prayers are warmly welcomed....

[Guest guest]

Hi ,

This happened to us as well (Blue Cross was our insurance, too). It also

occurred about 5-6 weeks into treatment. appealed and we got put on the

7-day review cycle as well. From there on in, we were denied every week.

would appeal and we'd get 7 more days. Several times our son's

psychiatrist spoke directly with the Blue Cross physicians and it just irritated

the heck out of me that he was having to do that (I was grateful he did, mind

you) instead of spending time working with my son! Bottom line was that we went

four months like this before they finally really stopped approving treatment.

We ended up having to cover the fifth month out of pocket, but was really

good about this. They didn't bill us until a month or so after our son was home

and then they readily agreed to work out an interest-free deferred payment plan

AND to charge us the discounted rate Blue Cross was paying instead of the

full-on published rate. It was still a bundle of money, but really

worked with us. Another parent told me they were offered a sort of

" scholarship " to be able to extend their child's stay -- I think it was two

weeks. So, while it is extremely stressful, do know that there are options and

it probably won't be as bad as it seems when you first get that denial.

I am so heartened to hear that your son is continuing to gain weight -- that is

wonderful news!

Keeping you guys in my thoughts,

Lee in CA

Just when things were looking up!!

Okay, first the good news........my son is up to 118 lbs. now and is still

eating well, so that is awesome news. He's continuing to make progress as far as

participating in more activities and programming at 's and is turning some

corners in other areas.

Now for the bad news.......got a call from 's today that Blue Cross is

denying further coverage for my son to stay there. I can not begin to tell you

how devastated I was to get that call! There is NO WAY he is anywhere remotely

close to being able to be discharged and there are so many compelling reasons

why that I can not believe the Blue Cross doctor would argue this.

They're saying he's ready to go down to PHP (Partial hospitalization) but due to

his bathroom issues and other factors, there is no way a PHP would even take

him, not to mention the fact that that type of upheaval for him at this juncture

would completely do him in and send him right back to square one, or even worse.

I am so beyond livid about this I don't even know what to say. We have an

" expedited appeal, " which is a 24 hour turnaround, so we'll know by tomorrow

whether they overturn it, but even if they do approve him, it's only for 7 days

at a time. Once they put up a denial, then moving forward they'll do everything

they can to push the patient out on a weekly basis,

Bottom line, I will live in a tent if that's what it will take to keep my son at

's until he's ready to be discharged. Insurance companies are just flat out

disgusting how they could put a child's life at risk like this is completely

beyond me!!

If anyone might have suggestions on dealing with this type of situation with

insurance companies, please let me know.

Please cross your fingers, and prayers are warmly welcomed....

[Guest guest]

This is what is great about this group....Experienced parents can provide

support and info for those who are now going through something.

Just when things were looking up!!

Okay, first the good news........my son is up to 118 lbs. now and is still

eating well, so that is awesome news. He's continuing to make progress as far as

participating in more activities and programming at 's and is turning some

corners in other areas.

Now for the bad news.......got a call from 's today that Blue Cross is

denying further coverage for my son to stay there. I can not begin to tell you

how devastated I was to get that call! There is NO WAY he is anywhere remotely

close to being able to be discharged and there are so many compelling reasons

why that I can not believe the Blue Cross doctor would argue this.

They're saying he's ready to go down to PHP (Partial hospitalization) but due to

his bathroom issues and other factors, there is no way a PHP would even take

him, not to mention the fact that that type of upheaval for him at this juncture

would completely do him in and send him right back to square one, or even worse.

I am so beyond livid about this I don't even know what to say. We have an

" expedited appeal, " which is a 24 hour turnaround, so we'll know by tomorrow

whether they overturn it, but even if they do approve him, it's only for 7 days

at a time. Once they put up a denial, then moving forward they'll do everything

they can to push the patient out on a weekly basis,

Bottom line, I will live in a tent if that's what it will take to keep my son at

's until he's ready to be discharged. Insurance companies are just flat out

disgusting how they could put a child's life at risk like this is completely

beyond me!!

If anyone might have suggestions on dealing with this type of situation with

insurance companies, please let me know.

Please cross your fingers, and prayers are warmly welcomed....

[Guest guest]

Lee,

Thanks so much for sharing this with me, I can not tell you how helpful it is to

hear that there are options!! I did not sleep a wink last night, I was so

worried about this situation!

I had spoken with the woman there who handles insurance and asked what options

there were and what other parents do in this situation. She was very nice to

speak with and could clearly hear the desperation in my voice, but certainly

didn't offer any options other than a *slightly* discounted rate. She said we'd

have to come up with a 2-4 week deposit up front to keep him there while we try

to figure out the insurance issue.

We have Blue Cross of Illinois, although we live in another state, because my

husband's company is based there. The woman at 's said that Illinois BC is

one of the worst to deal with. One way or another we'll figure it out, but there

is absolutely no way my son can be moved from there at this juncture!

>

> Hi ,

>

> This happened to us as well (Blue Cross was our insurance, too). It also

occurred about 5-6 weeks into treatment. appealed and we got put on the

7-day review cycle as well. From there on in, we were denied every week.

would appeal and we'd get 7 more days. Several times our son's

psychiatrist spoke directly with the Blue Cross physicians and it just irritated

the heck out of me that he was having to do that (I was grateful he did, mind

you) instead of spending time working with my son! Bottom line was that we went

four months like this before they finally really stopped approving treatment. We

ended up having to cover the fifth month out of pocket, but was really

good about this. They didn't bill us until a month or so after our son was home

and then they readily agreed to work out an interest-free deferred payment plan

AND to charge us the discounted rate Blue Cross was paying instead of the

full-on published rate. It was still a bundle of money, but really worked

with us. Another parent told me they were offered a sort of " scholarship "

to be able to extend their child's stay -- I think it was two weeks. So, while

it is extremely stressful, do know that there are options and it probably won't

be as bad as it seems when you first get that denial.

>

> I am so heartened to hear that your son is continuing to gain weight -- that

is wonderful news!

>

> Keeping you guys in my thoughts,

> Lee in CA

>

>

>