Question
What is the name of your state?What is the name of your state? Washington resident, Oregon insurance co.
Insurance co. is denying a claim for long term treatment for my son. Treatment 3 doctors are referring. He is 18 Yr. and has diabetes and mental health conditions. The Mental Health problems are preventing him for taking care of his health care. His doctors agree with each other that my son will end up in state hospital system (not effective at treating insulin dependent diabetics), without this treatment. I don't want that to happen if there is an alternative. The Alternative exists: in Virginia, a hospital that specializes in treatment of this combination of conditions. If there were somewhere else his doctors would refer him. Do we have any options, the doctors are filling greivences but they are still meeting resistance.
Answer
On what basis are they declining?
BTW, the insurance company cannot deny your son treatment; they can only decline to pay for it. It is entirely up to you, your son and his doctors what treatment he receives; you are at liberty to find funding for payment outside of your insurance.
Answer
So far they have given 3 excuses, 1) they don't pay for "diabetes education": but they have in the recent past. 2) they don't cover Behavior therapy: But they paid for 2 behavioral treatment programs, and for the latest 3) take your choice a) they don't think that's the right place for him or b) we don't have "that kind of coverage" (would that be medical or mental, since we have both?).
On the second comment, your right, we do to the extent of our resources. But I'm not sure where to get $150,000+ or who might offer that kind of funding.
It's interesting that if he had cancer they would pay to treat him, but even with lab work coming back that his kidneys are suffering damage, they don't want to prevent-pospone very expensive complications and their treatment.