INSURANCE/MANAGED CARE TROUBLESHOOTING GUIDE FOR PARENTS

How do I to approach insurance and employers for help in obtaining coverage?

If you’re insurance plan does not cover RTC (residential treatment centers) or has minimal RTC benefits, you may want to contact the person at the employer’s company who is in charge of employee benefits. It is likely to be someone in Personnel, Human Resources or Insurance Benefits.

• Explain to the person that your child is experiencing behavioral and mental health problems (thoroughly explain what the problems are)
• Explain that you have found a facility whom you truly believe can help you and why
• Tell them that your request has been denied by the insurance company (or that the benefit is not enough for the problems your child is experiencing)
• Mention that this denial or lack of adequate coverage is causing additional stress and blocked much needed care for you and your child
• Ask the person to intervene on your behalf so that your child “can get the care he/she needs from a facility you trust.” Remind the person that the facility you are requesting has an accredited educational program, maintains all state licensure and JCAHO accreditation needed to serve as a preferred provider


You can also write a letter to the director of the employer’s insurance benefits department that contains all the information above. At the end of the letter, write “I’ll be coming into your office on ___________(date) to meet with you regarding this matter. I trust you will do all you can do to help me get the help I need for my child.”

When speaking to your insurance provider and informed that you have no RTC coverage (or no out-of-network coverage), you may want to ask the following questions:
• Can I flex my inpatient hospitalization benefits over to RTC?
• Can we make an “ad-hoc” provider status?
• Who can I speak with about an appeal?
• What levels of care do you cover?
• What level of care do you suggest?


Please feel free to call our intake department after speaking with your employer for additional assistance.