What to Do When Insurance Refuses to Pay for Son’s Extended Stay in Rehab Center?
Question by Thomas: What to do when insurance refuses to pay for son’s extended stay in rehab center?
My son admitted himself to a drug rehab center for an opiate addiction that he has had for about a year and a half. His poison was oxycontin. The Counselor told me that he was a fairly serious abuser and needed help. He spent 8 days going through Detox and his insurance (Aetna) refuses to approve payment for the scheduled “normal” 4 to 6 weeks of therapy, not to mention the possibility of a stay in a half way house after wards to ease him back into a normal life. I was told by a counselor that it would have been better if he was not insured so the facility could go through the state. There are many issues to resolve with my son before he can even attempt to live a normal life, but without the rehab I’m sure he will only be heading for more trouble. 8 days of detox in the last 1 1/2 years of addiction is certainly not going to help him. What can I do?? I have talked to the facility who claims it is not there decision, it is the insurance company’s. They readily acknowledge his illness and state that he needs rehabilitation. The insurance company ignores my questions since the Hippa laws prevent them from giving me any information since my son is 20 years old and are only allowed to talk to him. He is allowed to use the phone for 10 minutes every other day, and has not been able to make any progress. Isn’t normal for the facility to have a heavy weight who deals with the insurance company and confers the patients needs and condition? The facility is trying to deal with Aetna but I feel are going to release him on Monday the 17th. Has anyone else ever been in this situation? What can I do? Is there a state agency or government agency that I can appeal to??? My son is sick and he knows it, but I need direction as to what to do next. How do you fight the insurance company? what recourse do I have? Any help would be extremely appreciated as my sons welfare is at stake.
Best answer:
Answer by Iffy
remove him from your insurance and have him apply for medicaid. You cannot force an insurance company for something not covered.
Answer by Curious
Your story is hard to follow (I understand it’s a stressful time).
Is the insurance saying this is not a covered benefit? Or it’s covered, but there is some reason why they aren’t approving it for him?
To check if it’s covered = you need to know the exact name of his plan and you should be able to find the specific details of his plan online. If you can log into his insurance account online, that’s the easiest way to check (maybe he never set it up, which you could then do for him). Aetna has a great website. I used to be an Aetna member and I still use their website for information.
– if detox / rehab is not covered under the plan, it’s doubtful there is anything you can do. The plan he (or his employer) picked doesn’t have this as part of their benefits. Just because you need it now, you can’t add it now.
If it’s allowed benefit, you will need to appeal the denial.
Your son should be able to provide you with “consent” to review/discuss medical information (ie. override HIPAA privacy). This would be a notarized document. It may need to be as “powerful” as a medical power of attorney (this would provide you with complete authority over his medical treatment).