NORTHWEST ARKANSAS, Ark. (KNWA) – Carie adopted her son with behavioral health issues when he was three years old.
“I’ve always said that I’ve become an expert in areas I never wanted to be an expert in just trying to have to fight everybody to get him the care he needs,” Carie said.
Now he’s 11. He’s a member of the PASSE – a program that serves Medicaid clients with significant mental health needs and developmental disabilities.
“He has no empathy and he has no ability to have that he doesn’t get it – he doesn’t understand,” Carie said.
Carie says her son has been to three residential treatment facilities. She claims insurance has denied services because her son had stayed too long or it wasn’t working. That forced her son to come home off medication and without a transition plan.
“Do I think that he could live a normal life outside of residential facility – absolutely – but he has to be given time to be given the tools and the right medications for him to get the help he needs,” Carie said.
At his third facility, he was diagnosed with autism and bipolar disorder.
Then, Carie says her insurance changed from Summit to Empower.
“As of December 1st, we already have our first denial,” Carie said. “It’s just something that I don’t think is fair that he can’t get the help he needs.”
In a notice sent to the facility- Empower states her son doesn’t meet the criteria for inpatient care. Empower had a doctor review the case and determined he was safe to go home. But Carie says the doctors at the treatment facility disagree.
“They’re in the rooms they know these people they know what’s needed help the doctors help the people and stop letting insurance run the show,” Carie said.
We reached out to DHS to ask why PASSE program doctors have more say in the patient’s treatment options. It couldn’t comment specifically on this case but it did state for residential psychiatric treatment – a review is conducted to determine necessity.
“They don’t know my son,” Carie said. “They’ve never met him.”
DHS also stated that kind of treatment for children is not meant to serve as a long-term care option.
“There’s a lot of issues that need to be tracked – a lot of changes that need to be made and I don’t know where that begins I just know that I’ve had enough.”
Carie says her son went to his first facility in 2018. It was a behavioral center out of state. Carie says services were denied after her son spent over a year at the facility and wasn’t showing development in the program.
“We tried appealing, it got denied and he had to leave,” Carie said. “I knew him coming home off his meds was not a good plan so we moved him to a different facility for medication treatment.”
Carie says he spent two weeks getting medication treatment before he was told he had to leave. That was in October.
“They said he has to go, he’s done – we’ve done all we can do for him, ” Carie said. “Even though they did a medication change that day and I asked if that would prolong his stay and they said no.”
Carie said she picked up her son on a Wednesday – by Friday he was threatening to hurt himself.
“I had already found him another facility to go to and he was going to go on Monday and he told me if I sent him there, he was going to kill himself,” Carie said. “He’s 11.”
Carie was soon able to get her son into his third residential treatment facility – where he was diagnosed with Bipolar and Autism. But in November, Carie’s insurance changed. In December, she was notified the service was denied because her son’s behavioral issues had improved and he would better benefit from outpatient care – she claims the doctors at her son’s facility disagree.
“If he’s unsafe in the 48 hours he was in our home, why would we do that again,” Carie said.
She says the doctors are working to appeal.