coverage for residential treatment IP: 184.108.40.206 Posted on September 18, 2007 at 08:24:43 AM by joseph guido
My daughter is having some troubles again and we are trying to get her admitted into a residential treatment program through the university of Cincinnati children's hospital.
We are employed by a company based on Buffalo and the insurance (Blue Cross Blue Shield of Western New York) is based there as well.
Under the provisions of Timothy's law, Simone's condition qualifies for 'expanded services' .. so (subject to medical review) the 30 day limitation for inpatient coverage currently attached to our policy is not applicable. This has been verified with the insurance company.
However, I have now been told that our specific policy provides no coverage for residential mental health treatment. Since there is no coverage at all they are saying that the expanded coverage provision does not apply. Apparently they consider residential treatment different than inpatient services.
I have talked to the insurance company and they have not been able to point to a specific exclusion for residential treatment. I would seem that the parity provisions of Timothy's law would require that coverage be provided.
I am not sure if they insurance company is just using the verbiage of our policy against us (since the term 'residential treatment' is not specifically included).
My feeling is that the intent of the law would be to provide treatment ... especially because the issue with 'Timothy'
was the inability of the parents to get him back into a residential treatment program under their own insurance (they had him in a program when he was a ward of the state, but could not get him back in once they regained parental custody).
Our daughter has a condition called schezoeffective disorder and has been hospitalized 3 times in the last 5 years. She just turned 13 years old.
We are desperately seeking any help in getting the insurance company to follow the intent of the new legislation.
If residiential mental health treatment is not covered .. then the new law has no real impact, since the inpatient hospital units are designed for acute events and stabilization of the kids .. not longer term treatment.