As more and more employers move away from traditional healthcare plans and into the managed care arena, the coordination of benefits becomes increasingly more important.
Who's managing your risks associated with Mental Health/Substance Abuse benefits?
Managed care buzz-words like: Pre-authorization, pre-certification, eligibility verification, plans of care and discharge planning, all have strong applications within managed care plans. Failure to understand these terms and their requirements can be very costly mistakes. Without this knowledge and without assistance, employees are left alone to fend for themselves. When this happens, one of two things typically occurs - - they do not seek help and the condition/problem worsens, or they seek a higher and more costly level of care than what is needed to resolve their problem. In either event, the employee (increased out-of-pocket expenses), the employer (self-funded plans where a claim dollar is always at least a dollar), and/or your fully-funded benefit plan (increased premiums), all stand to lose.
At HMSA, our clinical staff are all experienced at working with you, your employer, your healthcare plan and the treatment providers within your community, to ensure that any out-of-pocket expenses are limited to your co-pay and/or deductibles and that the intensity level of care is matched with the severity of the problem.