Willoughby man fighting heroin addiction upset with rehab insurance denial by Ohio CareSource

Family said heroin rehab was pre-approved
Posted at 11:38 PM, Apr 07, 2017
and last updated 2017-04-08 00:40:59-04

A Willoughby family, dealing with heroin addiction for more than eight years, is upset critical rehab insurance coverage for their son has been denied by Ohio's CareSource non-profit insurance plan.

Denise Wilczenski and her 27 year-old-son Matthew told News 5 they received pre-approval for detox at University Hospitals Geauga Medical Center in Nov. 2016, but then several weeks later was sent a notice coverage was denied.

Denise Wilczenski said she and her son called CareSource for an explanation, but claim they were given no information on the denial of coverage.

"My son and others, who need heroin rehab and detox are now being turned away," Wilczenski said.

"It's just not right, and people at the Geauga Medical Center aren't happy about this."

News 5 contacted University Hospitals about this case, and it pledged to look into the situation.

CareSource quickly responded to our story and said it could not get specific about the case due to medical information laws.

CareSource issued the following statement:

"At CareSource we have a comprehensive case management and treatment plan for members who are faced with opioid dependency.

Any time a member believes an adverse decision has been made about their treatment we encourage them to first work with their provider to make sure their paperwork has been accurately submitted.

When a member’s health is affected by a treatment decision we encourage them to contact a Customer Care Advocate to initiate an urgent appeal at 800-488-0134."