Tuesday, January 27, 2009

BCBS's all over the place across the US in terms of pre-author for Mental Health services

Vast amount of confusion as indicated by postings on the Div 42, Independent Practice, of the American Psychological Association, pertaining to BCBS pre-authorization or not.

NC psychologist states that pre-author is being required but it is not clear if this is associated w/ 'federal employees' who have BCBS or BCBSNC across the board.

(Of course if, like me, your family of three pays $750/ month with a $2500 deductibe for anything other than going to the doctor, you don't get mental health benefits except at the 50% vs 80% rate, as you're not in a BCBS group plan).

This post from a mental health provider in Minnesota:

"Although a bit different, BCBS of Minnesota just enacted a similar requirement for Federal plans: they now require a pre-authorization for ANY MH services to be paid, even if you had been seeing the person in 2008. Typically, we got 8 session up front with no questions; we now have toeither call in for a verbal auth # or write a prior to get those first 8sessions. Of course, the announcement of this change came in mail in theform of a letter that looked like junk mail that many providers do not readcarefully. The announcement also was "wrong": it says you must submit IN WRITING, prior to the first session a request (even for people whom you havenever met before); they then retracted the "in writing" requirement with"verbal is ok", but only informed their staff of the change(staff admittedthey too were confused). Some of my colleagues are getting claims denied andwondered why---"you didn't call in"---..."

Department of Insurance NC suggests I could obtain a BCBSNC group policy for my three family members

I had enquired of The NC Department of Insurance as to why my BCBSNC Advantage (!!!!) plan benefits indicated that my mental health benefits were to be paid at 50% reimbursement instead of what I had believed was state law re: mental health parity. I was wrong; mental health parity laws in NC (and I betcha! federally), do not cover families who buy their own expensive health insurance.

There are more than 2.5 million people in NC who have the same kind of insurance that I have.

Because I have an individual plan (my family of three), I do not get this benefit. So, my family pays $750/ month for three healthy individuals and I do not get:

screening colonoscopies
diminished mental health benefits

But I got free medications yesterday!----which would have cost me about $40 out of pocket!

I'm gonna go ask BCBSNC if they can create a group policy for three people, as suggested by the Department of Insurance. I'm sure that will be no problem at all.

I'm gonna do that today and heck, I'll just suggest to my impoverished patients on Medicaid and letem know that all they need is a different frame around their reference points. Why, you could go get a full-time job! Who needs a disability check? Here: I've got the newspaper and we can look thru the want-adds just for fun.......

Or maybe that psychiatrist in the School of Medicine over in Chapel Hill who advocated in his opinion piece that gee, let's just all get some good mental health this year----that should be our goal this year----to which I responded: ahem: one of the matters usually associated w/ mental health is having a job. If people who receive SSI checks cannot work more than about $200/ month or less without wrecking their checks and their lives----and if no one is hiring part-time and if you can't get to health insurance if you are part-time.....

Aw, forget it. Just get a new frame; just go create that group policy for three people in a family.

January 27, 2009

Dr. Marsha Hammond
RE: File Number. 2009-01-01501
Mental Health Parity NCGS § 58-3-220

Dear Dr. Hammond:

Your correspondence to Representative Verla Insko has been forwarded to the North Carolina Department of Insurance since your inquiry pertains to insurance laws regulated by this department.
The legislation regarding the Mental illness benefits coverage can be found in North Carolina General Statute 58-3-220. I have enclosed a copy of this statute for your review.
Review of the information provided indicates that the coverage in question is the Blue Advantage Plan issued by Blue Cross and Blue Shield of North Carolina. The Blue Advantage plan is the individual plan that Blue Cross issues, and therefore does not fall under the attached statute regarding mental health benefits, as the statute only pertains to group coverage. Mental health coverage for the Blue Advantage Plan is as stated in the policy contract. Group plans can range from 1-49 for small employers and 50 and up for large employers. No matter the size of the group, the mental health benefit requirement for group coverage remains the same.
We hope you win understand that our legal authority in such matters is limited to ensuring the company complies with the terms and provisions of its policy contracts and complies with relevant insurance laws and regulations.
I regret our efforts did not produce a more satisfactory resolution for you. If you have any questions or if we can assist you on any future insurance related matters, please contact us.

Nichole Faulkner, PCS,AIRC,ALHC,FLHC (sure a long list of expertise; what in the world do those stand for? I have no idea)
Insurance Specialist 919 807 6774


§ 58-3-220. Mental illness benefits coverage. _
(a) Mental Health Equity Requirement. - Except as provided in subsection (b), an insurer shall provide in each group health benefit plan, for the necessary care and treatment of mental illnesses that are no less favorable than benefits for physical illness generally, including application of the same limits……

Saturday, January 10, 2009

BCBSNC states it will pay for 80% AFTER DEDUCTIBLE for Medical Benefits & 50% AFTER DEDUCTIBLE for mental health benefits

What a joke all the insurance matters have become. Any possible way that the public can be
duped is utilized.

I just received my BCBSNC Summary of Benefits. My family of three has a modest insurance policy. For $750/ month, and a $2500 deductible, we get access to medications for a $15-50 copay; we get office visits for a reasonable fee (under $20). If we have to have surgery, mammograms, colonoscopies (covered by law! ya know), you have to meet the $2500 deductible before you can get reimbursement at 80%-----

all except mental health and substance abuse services.

My Summary of Benefits states:


"Combined in and out of network $2000 benefit period maximum per member, and combined in- and out- of network lifetime maximum of $10,000 per member, provided in all places of service. Any services in excess of this benefit period maximum or lifetime maximum are not covered services."

Covered: 50% AFTER DEDUCTIBLE In Network

Covered: 50% AFTER DEDUCTIBLE Out of Network.


Summary of Benefits:

Outpatient Services: 80% AFTER DEDUCTIBLE
Ambulatory Surgical Center: 80% AFTER DEDUCTIBLE
Inpatient Hospital Services: 80% AFTER DEDUCTIBLE
Maternity and Elective Termination of Pregnancy: 80% AFTER DEDUCTIBLE
Skilled Nursing Facility: 80% AFTER DEDUCTIBLE
Other Services: 80% AFTER DEDUCTIBLE

I dunno: print is pretty black and white. Why do my medical benefits get more extensive coverage (no $10,000 cap) versus what mental health coverage gets and why are services reimbursed at a rate DIFFERENT than the medical benefits when the state law indicates the following:


"New mental-health law to start
Insurance industry must offer equal coverage

Starting today, insurance companies in North Carolina must provide the same level of coverage for some mental illnesses that they do for physical ailments.
That means that someone being treated for depression or schizophrenia can no longer be charged a higher co-payment (or face other inequities in coverage) than someone being treated for diabetes or a broken arm...."


Really? I can't believe they get away with these kind of things.

Think you can get the Department of Insurance interested in these things? NAH.

Think you can get your state legislator interested in what impacts their constituents? NAH.

Been there/ done that. Shame 'em is what I have to aim for.