This is the actual text in a letter I wrote to the Insurance Commissioner in CT, asking for his help in dealing with insurance companies that would drop our son’s medical coverage for apparently no reason at all. This was a very frightening and horribly stressful time for my husband and I, because every time his coverage was dropped, that meant he would be discharged immediately, or we would have to pick up the very expensive bills. We couldn’t even come close to being able to afford even a week in these institutions!
Individual names have been changed.
Here is the actual text:
“Our son is currently at Marlborough House at Elmcrest in Portland. He was admitted there from Midstate Medical Center in November 1999. Since he has been there, our family has been going through a medical nightmare! We have been told that PHS would not continue to cover our son’s medical stay unless we all have family therapy — this child has a ten year history of mental/emotional issues that are all extremely well documented. Our son called the police on my husband and has threatened to kill him many times, as recently as two days ago, according to his current clinician at Elmcrest.
PHS refused to cover our son’s medical stay as of December 6th. Our son also has a well-documented diagnosis of biologically based mental illness. Therefore, my husband’s insurance, Connecticare, picked up our son in December, and they have now approved him through next Tuesday.
Through all of this, we are now being told that our son should go to Foster-care, because he doesn’t need to be in the hospital, doesn’t meet the criteria for a residential program, and is too fragile to go home. I have also been told that unless I leave my husband (whom everyone considers the main cause of our son’s problems), I will not be able to have our son at home! He is in the Voluntary Services Program through DCF.
Our son’s Psychiatrist has been instrumental in helping us get our son the help he needs. He has done Doctor to Doctor consults and appeals, and feels that the opinions of the insurance companies involved, as well as the staff at Elmcrest are completely ludicrous! They have not communicated with the appropriate people, and neither has the insurance company.
How can an insurance company dictate lifestyle? Our son has had these problems since he was very young — way before I was ever married to my husband! We are being railroaded, but most of all, our son is being railroaded, damaged more than he was when he went into Elmcrest, and we have no help!
Please look into this matter for our family. We need your help. I have attached what pertinent documentation you need at this moment. If there is anything else I can provide you with, please feel free to let me know. You have my permission to speak with anyone involved in our son’s case about anything related to this situation. I can be reached at work at: xxx-xxx-xxxx, and at home at: xxx-xxx-xxxx, and by personal email at: xxxxx@xxxxx and at work email at: xxxxx@xxxxx.
Thank you for your time and consideration in this matter — our family, and particularly my son’s life, depends on it.
Most sincerely,
12/10/99″
This was how we appealed to the Insurance Commissioner, because since our son has a biologically based illness (meaning he was born with it and it is out of his control), he was protected under insurance parity laws. However, getting that protection in place and making it stick was anything but easy.
We were constantly threatened with Foster Care, Group Homes, and seemingly anything that had nothing to do with our son getting his mental health needs addressed. The pain that we went through during this time was almost unbearable.
Comments and questions are welcome.
