My son, age 19, is covered by both my health insurance and my husband’s. Both are through our employers and in the state of Oregon. My son will begin receiving SSI and Medicaid through the state of Washington. He lives with us. He has severe depression and anxiety problems, including ADHD, that has escalated to his not caring for his diabetes and some ADLs. His doctors are trying to get him into Cumberland Hospital for Children (they take patients up to age 22). The insurance company is fighting us all the way so we have hired attorney.

My son wants help and is willing to sign himself in, but is losing hope that he will ever get it. My son has spent time on two occasions as an inpatient at the mental health part of hospital in the last year. I’m on Federal Medical Leave to keep him stable while we pursue funding for his treatment at Cumberland (he has already been accepted for their program, upon funding being found). Outpatient treatment has not been successful. Does anyone know of other cases similar to ours and how they were able to get the help their child needed?

Unfortunately, I do not know of any cases similar to this. Does Cumberland Hospital have a patient advocate that can help secure insurance funding? I am assuming that your son’s two current insurance plans will not pay for a stay at Cumberland Hospital because it is out of state and is probably very expensive. If Cumberland has a patient advocate, the advocate may be helpful in describing what other patients have done in the past to get their insurance to cover a stay at Cumberland (ex. a strong letter from multiple doctors requesting an outwork of network referral at Cumberland).

I would also suggest that you look into what other mental health programs your son’s insurance will cover now. You said he was in two inpatient programs last year. If that was not helpful, is there another hospital that has a psychiatric unit that he has not been to that is covered under your insurance? If he does have another inpatient psychiatric admission, I would recommend that his current doctor be in touch with the staff at the inpatient psychiatric unit so that the inpatient psychiatric unit knows how to manage your son’s diabetes properly. As I am sure you know, uncontrolled diabetes can impact his mental health. Also, inpatient psychiatric hospital stays can be very brief, so, for some patients, it helps to attend a day treatment program immediately following a brief hospital stay, with extensive counseling and psychopharmacological follow-up.

DB
Additional comments from Dr. David Schwartz:

I don’t know the answer. I have only successfully had one patient admitted to Cumberland. I can understand Cumberland’s business mind-set, but I think that your primary care doctor and endocrinologist must be willing to write letters supporting this action on your behalf! I find that any such letter sent more “generically” to the insurer is not as potent as a letter addressed SPECIFICALLY to the Medical Director (with consideration of a copy noted sent to the state insurance commissioner). I also think, but don’t know this will happen, that Cumberland should be able to advocate on their own behalf. I’d hope that they have mechanisms to try to get insurance contracts.

DS