Can an insurer stop payment to a rehab facility if they believe the patient is well enough to go home?

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Can an insurer stop payment to a rehab facility if they believe the patient is well enough to go home?

My 20 year old daughter, who is borderline retarded, is in a residential treatment facility. However the insurance company believes that she’s well enough to return home but the facility recommends continuing treatment. She has been in similar facilities since she was 16 1/2 years old, due to dangerous behavior. What legal resource do I have to show that if she comes home too early she’ll be overwhelmed and could revert to her old behaviors and threaten her safety and the safety of others?

Asked on June 2, 2011 under Insurance Law, Connecticut

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

In general, insurance companies can also kick a patient out of a hospital if the insurance company believes no services are needed and/or the insurance runs out. You need to protect your daughter but in a legal fashion. So at this point, resort to as many creative options as you can. Start corresponding with the insurance company verbally and in writing and start conversing and writing your congressmen and senators (both at the local, state and federal level). Talk to the local paper. Your final options are to file a complaint with your state's department of insurance and to hire an attorney. You should be also obtaining professional independent opinions about your daughter's need for care and what could or would occur if she was sent home from the facility.


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