My teen needs rehab but we have terrible insurance

In the process of trying to get a Single Case Agreement thru our mental health insurance- HMC Healthworks. (changed to Uprise recently) but the admin at Newport Academy said it doesn't look good because they probably won't pay their rates. I believe her and I believe when she calls me back tomorrow the answer will be no, after all the insurance company has only 1 psychiatrist that accepts their insurance near us. Does anyone have advice on next steps when they refuse the single case agreement? My 15 year old has been hospitalized twice in the past for depression and anxiety, and now she needs a rehab. (Think- oxy, weed, coke)  She is dual diagnosis. Has a therapist and psychiatrist and is taking meds but she's out of control (lying, sneaking out, verbally abusive "I hope you die' 'I'd kill you in a purge', 'fuck off', etc.. cutting, trading pics and actual sex acts for drugs, (apparently they just VENMO each other for that!!,)   skipped almost her entire sophomore year, OD'd last month, threatening suicide when I won't let her see her friends or when I take her phone... So she needs a higher level of care. I'm at a complete loss. We cannot afford to pay without insurance, we can't even afford a private consultant. Isn't there some kind of insurance law the company has to pay for care like this?

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Hi there. I'm so sorry for your situation.  Yes there is supposed to be parity, but insurance companies all the time limit services and then while you might win a lawsuit, your child and family suffer in the meantime.  I am not exactly in your situation but we did have mental health issues making school attendance unsafe and impossible and now my kid's IEP has them in a residential therapeutic school that provides both the educational and therapeutic pieces. (Though not intended as respite care we are nonetheless getting respite as a result and it is saving our family).  I am wondering if your quickest route (and by quick I mean a few months) would be through your school district.  Your child is entitled to an accessible education; if mental health issues mean a higher level of care, more structured and contained environment is required to achieve that, the district is supposed to provide it.  In any event, you can get solid information about realistic and reliable next steps via https://dredf.org/  and https://www.willowsinthewind.com/  and  WTRS: Wilderness Therapy and Residential Treatment Search Support on Facebook.   Wishing all of you peace and ease. 

It sound like RTC is needed. This is long term Residential Treatment. If your child has an IEP the District will pay. These programs include mental health and some are also specific for substance abuse. Some resources are Willows in the Wind parents support which meets online monthly. Also Facebook has an Wilderness Therapy and Residential Search group (WTRS parents). Check them out. You can also contact DREDF here in Berkeley for advice on IEPs.  

Hi.

 I am broken-hearted by what you have and are going through. Never having had these experiences, I cannot imagine the pain that you and your daughter must be in. If ever there was an example of why we need universal insurance, this is it.

 I believe California law does require your insurance to cover rehab and mental health services in parity with its physical health coverage. This bill was signed into law in 2020 and went into effect in 2021, despite massive pushback from the insurance industry.

You might consider contacting Disability Rights Education and Defense Fund (DREDF) for guidance and support. They may work with you directly, or refer you to other resources.

 I will be keeping you in my heart and hoping your family can access what it needs. Your daughter may not realize this, but you are an amazing, loving, and very hardworking parent who is dealing with an impossible situation. Please don’t let despair drag you under. Remember to find ways to take care of yourself through this time.

I wanted to reach out and just say I have so much empathy for you.  My teen daughter has also been hospitalized multiple times and has similar issues of suicidal ideation and self harm - dealing with it all has been the darkest nightmare.  I don't have an answer to your insurance question, but I wanted to recommend a group I found helpful: family sanity.   Just google FamilySanity.org.  It's a support group but the two women who run it and the other participants know a lot about how to get insurance companies to pay for things, how to deal with the public school IEP process, all of it.  I have learned so much and I would never have figured it out on my own.  

Hi—I am so sorry that you are going through this. My family has experienced something similar. It is awful and you are not alone. 
if you kid was enrolled in public school, you may be able to get the school district to pay for residential treatment. The process is not easy, especially while you are dealing with everything else. I highly recommend investing in a few hours with education attorney Deborah Jacobson in Berkeley. Of all of the people that I interacted with when I was in the thick of navigating finding treatment, she was like a breath of fresh air. I can’t remember exactly how much we paid her (around $1200) but we got many, many times that amount in cost savings. Someone at her firm may be able to do a quick free consultation to help you figure out if she can help you. Best of luck. 

If/when you are denied by phone, ask for the denial in writing and ask to file an expedited appeal.  Keep a log of all communications (names/dates/titles).   Do a web search for a DMHC complaint. Familiarize yourself with the California dept of Managed Health Care process for filing a complaint and/or requesting an IMR.  DMHC has the power to overrule a health plan. 

Are you familiar with Willows in the Wind, an organization by and for parents with troubled teens who need residential treatment?  info [at] willowsinthewind.com There are monthly meetings in Oakland, Los Altos and San Rafael.  They may be able to connect you to someone who had the kind of experience with insurance that you're having.  Even if they can't, it's a wonderful support and resource. willowsinthewind.com / info [at] willowsinthewind.com  Best of luck.

If your teen is in public school and has not yet graduated high school, you should get an IEP. This may help pay for the cost of rehab. Write to your school counselor and the district head of special education. It’s supposed to be 15 days from the start of the school year, at least in my district. Good luck

I am so sorry you are in this horrible situation with little support. Please consider contacting Willows in the Wind and NAMI SF. Both organizations have free support groups that have been invaluable to me with my teenager now young adult struggling with mental health and substance use challenges. The lovely people there can point you in the right direction to get your daughter the care she needs.

Do something kind for yourself today and everyday while you navigate your way through this. You are not alone.

Ask the school district for an special needs evaluation.  They are responsible for providing her an education- sometimes this stems back to learning differences and it expresses itself like this if it isn’t caught in earlier years.  They can’t blame it on drugs too- go from the grades and truancy part.  There is a federal law that states they must locate and find children till the age of 21 of any special or extenuating need.    I’d say a child not attending school is that category and they must help you deal with this.  It’s just an avenue to consider.  The thing to remember here is little issues become bigger ones when they get to be a teen, so the school may have failed you guys earlier.  I’ve seen huge law suits over this in public schools- though the kid isn’t elementary age anymore- they may not have picked up on something earlier that turned it into this- and now your kid doesn’t “have access” to her education due to these issues.  I encourage you to look into this box for support.  It won’t be easy figuring out the “language” but often getting an education assessment through the school district is a place to start.  Then you can demand psych educational testing at the district cost if the Ed testing done by the district isn’t turning up anything.  So sorry you are going through this!  my guess is some of this was there before but in expressed in another form.  You are a great parent to reach out!  
 

https://www.understood.org/en/articles/child-find-what-it-is-and-how-it-...

So sorry you are going through this- I've been there and would not wish this experience on anyone.  

I know you mentioned a private consultant may not be an option but I highly suggest you work with one.  There are a lot of programs out there and it can be really overwhelming to find the right fit for your daughter.  And a good ed consultant will know the schools that offer payment plans or are more flexible working with insurance.  Review your insurance policy- see if there is any coverage for substance abuse disorder. If there isn't, they aren't going to cover but if there is they should negotiate the rate with a provider who does take your insurance.

Paying for all this is crazy expensive.  My carrier now covers detox, rehab, even sober living but they didn't when this journey started for my family over 4 years ago.  Back then I had to pull money out of the house to help cover the cost of a therapeutic boarding school.  

One option others I know of have leveraged...  Does your daughter have an IEP or other special ed services at school?  Have you reported to the school the issues you are dealing with?  If you have a history of reaching out to her high school for assistance and support and have documented her current needs but they have not made any accommodations you may be able to get the school district to pay for treatment.  I know a number of parents in a similar situation who have been successful going that route- you'll need a lawyer who specializes in exactly this but if you've got history of reaching out to the school and her needs have not been met you have a good chance of the district paying.  It is worth the consult to find out.

You mention your daughter has threatened suicide.  Have you had her admitted under a 5150 psychiatric hold?  That might help to get things moving for other avenues of support.  It's really, really important to do everything you can now before she turns 18.  

You didn't ask but I will mention how important it is for you and your partner to get support for yourselves.  I have found and still find peace (plus a great resource) in NarAnon.  It is for friends and families dealing with the disease of addiction and you can always find a meeting virtual, in person just about anywhere.  Taking care of your own mental health is super important along with accepting what you can and cannot control.  

Again I am sorry - it is truly an awful situation to be in but finding others who have walked this path can be extremely helpful.  

I am so sorry that you are going through this. I have traveled this road as well and just want to heartily support contributors suggestions about Willows in the Wind, Family Sanity, and getting an IEP for your child. We got one for my child even though they were not enrolled in the public high school at the start of the process (we enrolled them, then started the process.) A kind facilitator from Willows walked me through every step, and from the moment the IEP was granted, the district paid for my child's residential treatment. I also want to call out another exceptional local resource: Coyote Coast in Orinda. Check out their web site. They began as an organization helping families cope with kids returning from residential programs, and have expanded out to help families possibly prevent sending their kids away. I only knew about them after my child went away, but we worked for a year with Alex while my child was in treatment, and Coyote Coast helped smooth they way for my child's transition home. I wish you all the luck. You're doing a good thing for your child and for your family. It's hard as all get out, this work, and I hope that you can get the help you and your family need. Take care.

Hi there, 
As a formerly out of control teenager who was doing everything your daughter is that you mentioned in your post, I sympathize with what you're going through. I was in an outpatient program three times during my high school years. I'm fortunate in that I got sober by the time I was 26 and still am to this day (9+ years). Al-Anon or Nar-Anon may be a starting place where you can take care of your own emotional health while connecting with others who have been in the same position. They can offer you support and guidance in the right direction, especially if you attend local meetings. I would be happy to connect offline if you have questions. Sending my best.