Insurance Stinks!

Kitty who has RAD, complex PTSD, bipolar disorder, ADHD, LD, ODD… and a half a dozen more letters was placed in residential treatment on 8/19. This year she’s been hospitalized twice for suicidal issues, and went to a partial day hospitalization program that made her worse because the kids were out of control and the staff didn’t do anything about it. We pulled her out after 3 weeks, because we couldn’t handle the almost daily rages at home anymore. She has always behaved well at school and in public of course. Gotta love RAD!

This Summer I stayed home and we made her life as simple as possible. Grandma watched the other kids and I stayed near Kitty to help her regulate and stay calm (she can’t do it on her own). She verbally threatened the life of Grandma and our youngest son, MANY times. I don’t know that she would actually follow through with physical violence to them or herself, but that does mean I don’t want her to be in the care of Grandma with her little brother around all Summer. Meanwhile we started the process to get her authorized for residential treatment (RT).

She was adopted from another state, Nebraska, and we had RT written into her subsidy because TX Medicaid doesn’t cover it. So the RT recommended we get their pre-authorization prior to going through our primary insurance. Took them 3 weeks to say, well it’s up to your insurance, but we’ll cover her as long as we deem it’s medically necessary. When we talked to our primary insurance they approved it and she was in the facility the next day! That was the good news.

8 days later our primary insurance said she didn’t need to be there, because she wasn’t acting out. My child has RAD, so her issues are mostly with family. Plus, although it almost killed the family, she’d spent an entire Summer almost stress free. Hello! Can you say honeymoon?! The RT appealed because they saw the need to have her there (for one thing, she didn’t talk much, but had told the psychiatrist that she had suicidal thoughts). Appeal denied. They contacted NE who thought about it for a couple of days then left a message after hours saying they were refusing to cover her either. So she comes home tomorrow.

We are flat broke so the RT will have covered 9 days out of their pocket! They also pushed all the neuropsych testing (the main reason we chose them) and it will be finished today. (Can’t wait to see the results although we’ll probably have to wait a couple of weeks). Contact me off-list if you want the name of this RT. They do not specialize in RAD and are VERY expensive if you don’t have insurance, but they are great to work with.

So at least we got 2 ½ weeks of respite out of this and the neuropsych testing (our insurance doesn’t cover any mental health testing which seems short sighted to me). *sigh*

Mary in TX
http://marythemom-mayhem.blogspot.com
Mom to biokids Ponito(10) and his sister Bob(13)
Sibling pair adoptive placement from NE 11/06
Finally finalized on Kitty(14) on 3/08 - 2 weeks before her 13th birthday!
Finalized on her brother Bear(16) 7/08. He turned 15 the next day.

" Life isn't about how to survive the storm, but how to dance in the rain."