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Mental Health/Behavioral Health FAQ's for Yale Faculty and Staff

How is the mental health/behavioral health benefit changing?  We are leaving behind our old benefit which includes deductibles, co-insurance, and annual and lifetime limits. The new benefit aligns with our outpatient coverage outside of Yale Health.  This means there are no co-pays, no deductibles and no annual limits for pre-authorized treatment by a network provider.


Who are the network providers?  We have a local network of mental health professionals in partnership with Magellan Health Services, a nationwide leader in mental health care. Magellan maintains a comprehensive network specifically designed for Yale Health that includes psychiatrists, clinical psychologists, clinical social workers, psychiatric clinical nurse specialists, alcohol/drug counselors, hospitals and treatment facilities. In addition to its existing providers, Magellan worked closely with Yale Health to add providers to the network to meet our members’ needs.


How can I check to see if my outpatient provider is covered in the network?  You can call Magellan at 800-327-9240 or TDD 800-456-4006 to inquire if your current provider is part of the network or to get answers to your benefit questions. Beginning January 1, 2010, you will call this same number to obtain authorization for mental health/behavioral health and substance abuse services.


Is there a cost for using the mental health/behavioral health benefit?  There is no cost for pre-authorized treatment by a network provider.


If my provider is not part of the network, will my care still be covered by Yale Health?  No, coverage is only for pre-authorized care by a network provider.

Prior authorization – what is it and how do I get it?
All levels of care require prior authorization. By obtaining prior authorization for care, Magellan can ensure the appropriateness of your care, and refer you to a participating provider so that you do not have any out-of-pocket expenses. Beginning January 1, 2010, you will need to obtain prior authorization of all mental health/behavioral health services by contacting Magellan at 800-327-9240, TDD 800-456-4006.

What services are available through Magellan Health Services?  Magellan offers you a number of different services to best meet your needs. Along with your Yale Health mental health/behavioral health benefit Magellan provides Yale University an Employee Assistance Program, now called Counseling and Support Services. The services include confidential, solutions-focused, brief consultation or counseling for all types of personal issues. You and your dependents also have access to a full range of behavioral health services, including treatment for stress, depression and anxiety as well as more complex mental health illnesses and treatment for substance use issues.

How do I access services?  You can access services 24 hours a day, seven days a week by calling Magellan at 800-327-9240, TDD 800-456-4006.

What is a referral?  A referral is the process by which Magellan provides you the name and contact information of a mental health provider for the purposes of diagnosis or treatment. If you requested that Magellan give you the names of several providers, it is important to call Magellan back to let them know the name of the provider that you have selected. Magellan will then authorize the care.

What if I am currently receiving mental health/behavioral health benefits from a provider and I want to continue with that provider after January 1, 2010?  If your provider is in the Yale Health/Magellan network you will need to call Magellan at 800-327-9240, TDD 800-456-4006 to get prior authorization. If your provider is not in the Yale Health/Magellan network you have two options.  You can call Magellan and they will assist you with selecting a network provider and prior authorization. Or you may choose to utilize an extension of the old benefit and stay with your current provider through June 30, 2010.  With the transition plan the $100 annual deductible, $60/visit reimbursement up to an annual maximum of 30 visits and a lifetime maximum of 150 visits will apply.  Complete details of the transition plan can be found here www.yale.edu/Yale Health/news/transition_plan.

Does my PCC need to refer me to a mental health provider? No. You can call Magellan directly at 800-327-9240, TDD 800-456-4006 to access mental health/behavioral health services.

If Magellan only authorized a certain number of outpatient sessions, what do I do if I need more sessions?  If your provider feels that you need additional sessions beyond the initial number authorized he/she will work with Magellan to obtain reauthorization.

What do I do if there is an emergency?  When emergency care is necessary, please follow the guidelines below:

  • Seek the nearest emergency room, or dial 911 or your local emergency response service for medical and ambulatory assistance. If possible, call Magellan directly at 800-327-9240, TDD 800-456-4006 provided a delay would not be detrimental to your health.
  • After assessing and stabilizing your condition, the emergency room should contact Magellan directly at 800-327-9240, TDD 800-456-4006 to obtain your medical history and to assist the emergency physician in your treatment.
  • If you are admitted to an inpatient facility, notify Magellan as soon as reasonably possible.
  • If you seek care in an emergency room for a non-emergency condition, the plan will not cover the expenses.

What other services are available? Yale has an Employee Assistance Program called Counseling and Support Services that offers brief, confidential, solutions-focused consultation and/or counseling for all types of personal issues. The program is at no cost to you and is available for both you and your household members. The EAP commonly assists with stress, family or parenting issues, alcohol or drug dependencies, depression, anxiety, marital or relationship issues, adjusting to change, child and elder care, grief and loss, work life balance and much more. Whether you’re looking for information on health and wellness topics or you’re ready to seek personalized assistance, the Employee Assistance Program can help. You can access the EAP by calling 1-800-327-9240 or TDD 800-456-4006.

Are there excluded conditions and treatments? As with other Yale Health benefits there are some exclusions and limitations, see Exclusions and Limitiations.

What is the Mental Health Parity Act? The Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was passed in October 2008 and applies to the Yale Health.  The Act is effective as of January 1, 2010.  Regulations have not yet been issued. 

The new federal parity law will require group health plans to cover treatment for mental illness on the same terms and conditions as any other illness. Parity will be required in two specific areas:
1.      Treatment Limits. The new law requires equity – equal treatment – with respect to numerical limits (number of visits) on inpatient and outpatient services, barring limits on both services that don’t also apply to medical/surgical coverage.
2.      Financial Limits. The parity law also requires equity with regard to financial strictures, excluding any cost-sharing, deductibles, or out-of-pocket limits that don’t also apply to medical/surgical coverage.

What this means is that most plans will eliminate separate deductibles for mental illness or substance abuse treatments, and that if a cost or deductible doesn’t apply to medical or surgical coverage is cannot also be applied to mental health or substance abuse coverage, but any charges that ARE applicable to medical/surgical coverage may be applied to mental health and substance abuse as well.

Is there anything the new parity act does
not do? The new parity law does not redefine mental illness or addiction, or specify what is or is not covered. At present, the wording on that is nearly identical to the 1996 parity law, which says that such conditions are “defined by the plan” in accordance with State and Federal law, which  basically means that insurance providers and plan administrators will continue to define what conditions are recognized, and eligible for coverage benefits.

Does the Mental Health Parity Act require plans to cover mental health or substance use disorders? No. The Mental Health Parity Act does not mandate coverage of mental health or substance use disorder benefits.

 

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