Getting insurance to approve duration of stay needed at an RTC?


My 13 year old is at Newport Academy in Orange, Ca. She has generalized anxiety disorder, major depressive disorder and suicidal ideation. The program is giving her respite from our dysfunction while we try and learn how to be more emotionally supportive and calm and she learns skills for coping. We are making lots of progress but when she seems better I start to worry that insurance will want a discharge rather than see stabilization all the way through. A parent mentioned on a previous thread that she knew some ways to get insurance to pay and prevent going through the outpatient to inpatient to RTC cycle again and again. I’m hoping I can find that knowledable parent and get some advice. Having a suicidal teen is scary. I just want her to be safe and happy.


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Hi and so sorry you are going through this. We sadly cycled through 14 consecutive admissions over 3 months through our health insurance and our son had no education piece included at all, nor was any of the treatment effective in reducing his very serious symptoms. Through an education attorney, we used the school district route to place in a RTC in Utah and had a side-agreement with our insurance to cover "mental health services" while he was at the RTC. 

In terms of getting insurance to step in and step up, you need to read through the details of your benefits plan, document all denials for service, and formally file a grievance while notifying the California Dept of Managed Health Care. For our insurance, mental health services were pretty well disguised in our benefits plan and took some clever searching. One detail that helped us was having the various providers (contractors of our insurance that ran the various in-patient programs he was transferred to non-stop), write letters recommending RTC.

Advice for while you are in-paitent, be sure to make every meeting and respond to every request from the service providers so that they don't document that you are not open to the treatment plan, unfortunately this includes the 3am phone calls from service staff. As soon as possible, get copies of admission, treatment plan, and discharge summary documents for each admission, including the 5150's. Stay calm (yeah right!) and take care of yourself. Be aware that a DCFS (CPS) investigation may be initiated and be sure to warn any other family members, including siblings, that there may be an investigation and what that means, and that they have rights to not be questioned by authorities without someone else being present (or if a minor can politely decline and say that parents don't allow it). Call all schools and places of work and be sure to get in writing that you require a trusted adult to be present when there is questioning done by authorities.

Willows in the Wind is a great local support group that has experience helping families with kids in RTC's or considering other placements and services. I was quite lost in the emotional and financial devastation of trying to work my way through my son's mental health crisis before I found out about Willows in the Wind. 

Hang in there and know you are saving your child's life. Best wishes and kind thoughts.  

Ask for the Treatment Plan that the program has formulated for your daughter.  Insist that the facility adds goals that you would like to be on it, in order to be assured that your daughter is on the road to recovery. They cannot discharge her until she has completed her treatment goals.  So give your input to make the goals realistic enough to allow her to live safely at home with support.  

If they decide that she is healthy enough to come home, but you don't agree, you can write a letter describing why you believe that she needs further treatment (be specific, especially emphasizing safety).  That has to go to a treatment review panel and they often err on the side of patient safety and continue treatment.  Treatment has to continue until the review panel is able to give you a decision.


I'm wondering, since she is at Newport, if substance abuse is part of the problem?  If so, I wanted to let you know that there is a very intensive IOP in Pt Richmond that would be a good "step down" back into the community.  It is full day and includes on site academics, psychiatry, substance abuse counseling, individual, family and multi family therapy, adventure therapy, linkage to Young Peoples AA.  It's Contra Costa County (no cost for any/ no insurance). It's called CORE (Center for Recovery & Empowerment).  It's for Contra Costa adolescents w/ SUD & associated mental health disorders.