United Behavioral Health
Internet 84130
United States of America
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United Behavioral Health Denial of benefits, Internet
*UPDATE EX-employee responds: worked at UBH
1Author
0Consumer
1Employee/Owner
My daughter was addicted to drugs and had drug induced psychosis. Her psychiatrist sent her to an outpatient rehabilitation facility but she was not able to participate because of her state. He then recommended an inpatient facility.
I called UBH to find out an in-network provider and drove her over 200 miles to the facility. She registered and was staying at the facility but a week or so later, UBH sent a letter denying pre-certification. My husband and I made the decision to let her stay there to receive the help she needed with the intention of appealing the decision. After her release, we went through the appeal process to no avail. The facility required that we pay upfront for ther stay and they charged $38K.
I can't understand how they can dismiss a claim because "their doctors determined the level of care was not required". Her doctor and the outpatient facility both told us that in patient care was required.
I checked her benefits online and it states that if there is no pre-certification, UBH would pay at 50% but they also denied that. What is curious is that they did pay 20% of the claim.
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REBUTTALS & REPLIES:
1Author
0Consumer
1Employee/Owner
Updates & Rebuttals
#1 Ex-Employee
AUTHOR: jssoccer - (United States of America)
SUBMITTED: Monday, January 09, 2012
POSTED: Monday, January 09, 2012
I worked at UBH as a person who approves mental health stays at facilities. They have red or green days and when it is a red day, that means they are over the monthly budget and staff need to make denials for mental health care stays or threaten a denial of payment to someone already in care, in order to force a discharge of the patient. You might have the benefits but they sometimes make it hard to actually use the benefits on your plan.
If you stay at a facility without prior authorization, I would advise families to keep a log of all negative symptoms day by day so they can get the stay approved on appeal. On appeal the family can add details, so just tell UBH detailed info day by day that justified each day at the facility. Ask UBH to describe what is required at that level of care so you can tell them the negative symptoms that truly occurred. You have several levels of appeal. Give the info that wasn't in the original chart. You know your kid and what was happening each day. Get yourself a copy of the chart and piece in the missing details for each day to justify payment for each day.
