DONT Laugh at me...

DianaCox · Apr 28, 2017

You need to get a copy of your Evidence of Coverage to see how to demand an out-of-network referral because there is no local in-network provider. In the meantime, find a nice private RTC and demand that they pay for it. Your insurance company will quickly get a contract in place with the cheaper Medicaid place.

Charris · Apr 28, 2017

DianaCox said:
You need to get a copy of your Evidence of Coverage to see how to demand an out-of-network referral because there is no local in-network provider. In the meantime, find a nice private RTC and demand that they pay for it. Your insurance company will quickly get a contract in place with the cheaper Medicaid place.

The insurance company told me that for mental health I don't have any out of network benefits. I will contact them and see if I can get the EOC. TALK ABOUT catch 22.

I told them Phoenix is something like 4th largest city in the nation and there is no Rtc or IOP??

DianaCox · Apr 28, 2017

You may not have any OON benefits, but if they have nobody IN-NETWORK, they have to pay for OON.

Charris · Apr 30, 2017

DianaCox said:
You may not have any OON benefits, but if they have nobody IN-NETWORK, they have to pay for OON.

well THANKS @DianaCox and @Spiky Bugger . I called back and explained that I had found a nice RTC that my son would be quite comfortable at and I was expecting them to pay because I pay for the benefit and I want to be able to use it. I explained I know there are tons of famous people who Come to AZ for RTC -SA so I'm sure I'll be able to find one. I EVEN USED SUE'S EXAMPLE ABOUT PREGNANCY. LOL MIRACULOUSLY the rep who had reaffirmed at the beginning of our convo that there was no ETC WITHIN 200 miles of Phoenix found one! imagine that. it's in Chandler which is a 1hr away from me. I called the facility they said they had 1bed open. i said we will be there. She said you can wait till tomorrow morning. I told her no thanks we are on our way ASAP.So I had the kid pack his stuff and took his butt to detox at midnight. I DIDN'T WANT TO CHANCE SOMEONE else taking the 1 bed left.

DianaCox · May 1, 2017

Good on you, Mama Bear!! It's easy for us to give you advice, but it was much harder to actually be the mouthpiece that deals directly with the insurance assholes, who are professionals at being merciless.