My insurance company stopped paying while my son was in treatment
When the insurance company determines that care is no longer medically necessary and denies ongoing payment, patients have to make difficult financial decisions or are forced to stop in the middle of treatment.
Before my son entered residential treatment, I did my homework. I read my insurance plan’s explanation of benefits booklet to see if it provided coverage for substance use disorder treatment. I was pleased to find that it did! In fact, there was only one sentence devoted to coverage for substance use disorder, in contrast to the numerous pages devoted to coverage for medical and surgical services. So, I figured it was not a complex issue.
I turned out to be horribly wrong. Two days after my son was admitted into treatment, the director of the facility called me to tell me the insurance company was denying coverage. To say I was shocked is an understatement. The treatment facility told me I had limited options, all of which required me to pay thousands of dollars out of pocket to keep my son in treatment. I had to scramble and pull from many resources to keep him in treatment.
“I was stuck in the middle of an untenable catch-22 between the treatment facility and the insurance company, while my son was fighting for his life and my family was in crisis.”