Mental Health Benefits

Mental Health benefits are different amongst each carrier in the private market and are a cutback in benefits compared to employer provided coverage.

If you currently are covered through your employer, Mental Health benefits are covered the same as any other illness.  So...if your plan has a copay for office visits (out-patient medical services), than any therapy is covered under the copay...as long as your provider is "in-network"

In the private market Mental Health benefits are not covered the same as any other illness.  Below is a list of how each carrier the shoppe represents covers Mental Health benefits:

Aetna

Does not provide coverage

Blue Cross and Blue Shield of Illinois (BCBSIL)

12 month waiting period if considered a pre-existing condition.  All expenses are subject towards the plan deductible prior to being paid at 50% towards the plans out-of-pocket and after.

Celtic

12 month waiting period if considered a pre-existing condition.  All expenses are subject towards the plan deductible prior to being paid at the selected coinsurance level towards the plan out-of-pocket.

Humana

12 month waiting period, except for prescription drugs.  Separate plan deductible for Mental Health, then paid at 50% towards the plan out-of-pocket and after.

United HealthCare (UHC)

Mental Health benefit is additional premium with no waiting period.  All expenses are subject towards the deductible before being paid at selected coinsurance level towards the plan out-of-pocket.

Please call or email the shoppe with any questions.

Thanks,

Jordan

Office Visit Copay or Not???

Having trouble choosing a plan of coverage?
Do the plans that you can afford not have office visit copays?
Are they limited?

No matter which plan you choose the #1 benefit every member of each carrier receives is that they have access to the provider network.  When you seek service at a "in-network" provider you are subject to the negotiated rate of service, not retail..prior to the plan deductible being met.

The negotiated rate is applied to all covered expenditures.

All plans will cover preventative care services at 100% with no cost obligation to the insured.

So..back to having an office visit copay.

So, if your plan has a copay, then this is a fixed amount, on the negotiated rate, that you will pay for the cost of consultation when visiting a specialist or non-specialist.  The copay amount paid does not apply towards the plan .  Some carriers have 2 separate copay amounts, one for a specialist and one non (lower).

Clicking this office visit claim for a recent specialist visit of mine, will show the final cost I owe the provider after my insurance carrier, BCBSIL, processed the claim.  The retail cost was $170 in which I was only allowed to be billed $71.

If my plan had a copy I would have owed at time of service.  By not having a copay, I am billed this amount by the provider, and when paid, it goes against my deductible reducing my overall risk.

Keep in mind that this visit was for a specialist and I was an established patient.  If I had been a new patient, the retail cost would be close to $300.

Now, when choosing a plan you may notice that the copay amount is the difference in price between a plan without.  So..if you have do not visit the doctor frequently, the premium savings will be enough to cover the cost of your office visit consultation.

For any questions please contact the shoppe.

Thanks,

Jordan

HumanaOne Introduces New Plans Effective 1/22

HumanaOne will begin to offer new plans with more deductible options beginning 1/22/2011.

I have placed links to their new materials on the right side of my blog for your review.

These new plans will have more deductible offerings, plus condition specific exclusion riders.  What does that mean?  For applicants who apply to Blue Cross and Blue Shield of Illinois (BCBSIL) and receive an exclusion on a specific condition, Humana will come and offer a separate deductible for that condition.

Please contact the shoppe with any questions.

Thanks,

Jordan