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Opinion & Essays - Aug, 1991 Issue 

Insurance As An Overlooked Resource
Larry Stednitz, Ph.D.
(800) 328-1877

For every student placed in special purpose or treatment centers, placement consultants see at least ten students whose families do not have the resources to provide a much needed placement.

A frequently overlooked resource for parents is medical insurance coverage. Many basic medical insurance policies under the right conditions can provide valuable financing.

Family insurance often provides benefits for the treatment of psychiatric and substance abuse problems. If these benefits are available, medical necessity must be present to justify access to these benefits. Some of the criteria for medical necessity are:

  1. runaway behavior

  2. assaultive behavior

  3. incorrigibility

  4. promiscuity

  5. deviant sexual behavior

  6. suicidal ideation/attempt

  7. depression

  8. psychotic symptoms

  9. inability to perform activities of daily living because of severe symptoms, i.e., social withdrawal, agitation, anxiety, or severe depression

  10. depression with severe aggressive behaviors

  11. school failure

  12. uncontrolled or excessive drug or alcohol abuse

These criteria cover some aspects of medical necessity and need to be assessed by clinicians familiar with clinical diagnostic procedures.

Recent changes in the insurance industry have opened the door for utilizing this criteria for special purpose schools as well as treatment centers. These changes have been primarily directed at reducing escalating costs in the healthcare field. Also, the increasing use of case managers has facilitated the use of a wide range of programs which both cut costs and address unique needs of children and adolescents.

Matching clinical necessity and appropriate special purpose schools and treatment centers can be complex and challenging. Insurance benefits cannot be overlooked in the effort to assist families find resources to help their children.

Copyright 1991, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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