Do we have any rights to demand that our insurer cover at least some of our daughter’s stay in a residential treatment program?

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Do we have any rights to demand that our insurer cover at least some of our daughter’s stay in a residential treatment program?

My 17 year old daughter is being hospitalized for medical issues due to an eating disorder and other mental health issues for the 3rd time in 5 months. It is her psychiatrist’s insistence that she be placed in a long term residential program. Our insurance company is telling us that our employer does not offer any plans with residential coverage. We have tried other programs. She has been in a short term (1 month) program, intensive outpatient therapy, a day progam, and a three night a week program. They do offer inpatient care, but not residential care. What legal rights do we have? We need immediate answers. She needs to be placed in the next week.

Asked on July 26, 2013 under Insurance Law, Pennsylvania

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 8 years ago | Contributor

She is not entitled to the program. If your insurance doesn't cover it, you can try to see if you can buy private coverage or see if the state has any programs or if the facility offers grants or scholarships. Ultimately, if you file a complaint with your state's insurance department, you need to know it may take at least a few weeks if not a few months to get a response and the response may not be what you seek.


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