Mental Health Claims

[i10405]

I have mental health coverage. I have a 15 year old that is inpatient right now at a behavioral institution. (This is in NC by the way). Well, the insurance company refused to pay for my son to be in a facility close to our home, but yet, they will only pay for him to be somewhere 2 hours away, but the catch is that this facility will only take my child if he agrees to go. Of course, he does not want to go. (What 15 year old will). The place that my husband and I want to have him in is a wilderness camp where he can't run away and they also do not have to have his permission.....
Is there anyway that I can force them to pay anything. I don't have any out of network benefits, where they can control what I can do with my child????

 

[cbg]

If your policy does not have out of network benefits, then they are only responsible for paying an in-network facility and you cannot force them to pay for the facility you want.

 

[i10405]

You are right, I do not have out of the network benefits. But I do have inpatient benefits for long term care and can I file something to review what they have denied??

 

[cbg]

Without seeing your policy it's impossible to say for sure, but I believe most policies do give you the right of appeal. Depending on the type of policy you have, your state may require that you have that option. But if the facility you want for your son is out of network, an appeal will not likely change the ruling.

 

[SZQ_Public]

Wilderness Camp Info

i10405,

Do you have a link or advice on how to get info on this Wilderness Camp? Your post seems to indicate that this camp is considered "inpatient" treatment, is that correct?

 

[i10405]

Yes and no.... This used to be considered an inpatient theraputic treatment center and they now have changed their policy (meaning the camp) to a wilderness camp. Another words, they would pay for my child to be in a locked down facility, but will not pay for a wilderness camp. 3 Springs is the name of the wilderness camp and they used to be considered in network unitl I called insurance co and then they started to change their minds because they were not doing the things with the insurance co wanted.... My personal opinion is that wilderness camps are probably the best things for spoiled rotten kids like mine with an attitude and not some locked down facilty....

 

[SZQ_Public]

Thanks!

I looked through their website. It all sounds interesting. Especially the "outdoor theraputic" programs. BUT.. I'd think twice before sending my child to any program described as

continually challenges boys with a rigorous physical training program

Last year a child died in a so called "boot camp" program. I'm not saying there is anything wrong with this program, but I'd just be careful.

I think I'll talk to my son's school guidance councelor and get his opinion.

But thank you so much for the information. It is worth following up on. Did they give you an idea on cost? I couldn't find it anywhere on their website.

 

[i10405]

The program is about $150/nightly and is located in Pittsboro NC. I have seen it and the guide was actually done by a teenage child that was there and was really close to home... You can also email me at [email protected].. Any helpful information would be great... for the best interest of my child... Hopefully better. This child really needs help and I have done all that I can for him and given him more opportunites than most children don't have