Insurance Complaints

My daughter was diagnosed with an eating disorder. The Doctors strongly recommended inpatient treatment. However, my insurance (Medical Mutual of Ohio) does not cover ANY inpatient treatment for eating disorders.

I was advised (by a NURSE from Medical Mutual of Ohio) that inpatient treatment is not necessary for this “type of problem” and that they would only cover intensive outpatient treatment. I advised her that in the area I live, none of the treatment centers accept our insurance. She advised that this would be rectified by supplying a treatment center with a waiver of service to cover the costs at 80%.

I fail to see their logic behind this. After doing research on costs, it costs $2,500.00 a day for the intensive outpatient care they are willing to cover (for a total of $75,000.00 for 30 days) versus $38,000.00 for 30 days of inpatient care. Per the outpatient treatment center, my daughter will require at least 60 days of intense outpatient therapy to get her started. With inpatient, she would transition from inpatient to regular therapy/group after the 30 days. The success rate for outpatient care is 50/50. The success rate for inpatient is 95/5.

Unfortunately I am unable to make a NURSE understand that I trust a DOCTOR’S recommendation over hers.

Submitted By: MLS

Location: Wellington, Ohio Lorain County