Please check out the TWO updates about Value Options benefits and the transition from OptumHealth at the bottom of this post.
Although the Benefits Office previously informed the GC’s NYSHIP Coordinator Scott Voorhees that there would be no change in mental health/substance abuse provider for 2014, on Monday, January 6th, the word came down from NYSHIP that the provider, indeed, has changed.
The new NYSHIP provider is Value Options, though the NYSHIP Student Employee Health Plan (SEHP) At A Glance guidebook that was sent out recently still lists OptumHealth as the provider. A revised printing is being done and will be sent out. (FYI: The ValueOptions Group Code for students with NYSHIP is NYS023.)
Although the provider has changed, there will be no change in benefits. Any enrollee who received MHSA care in the last six months of 2013 should receive a follow-up letter from NYSHIP regarding the transition between to the new provider. Enrollees currently receiving care from an OptumHealth provider can continue to receive service through that provider at the in-network level for the first 90 days of 2014, regardless of whether or not that provider has added Value Options as of January 1, 2014.
Below, I have attached the letter that the Benefits Office has sent out to all NYSHIP SEHP enrollees (although mine hasn’t arrived yet… so much for timeliness after giving us the runaround on our 2014 benefits information).
UPDATE: A DSC representative called Value Options to get further information. Below is the helpful information and relevant links that the representative compiled:
- Optum Health will be processing everything from 2013 up until April so if you have claims send them to them before April. If you have a bill that they didn’t authorize sessions for yet, they will still do that for you up until 12/31/13 as long as you send them the info before April.
- Value Options has the same $100 deductible that we would have had with Optum Health.
- You don’t need authorization for the first 10 sessions but you’ll need your provider to fill out this form after 10 sessions to keep getting reimbursed.
- The claim forms are located here: https://www.valueoptions.com/mc/eMember/formsHome.do
- I gave them the info for my provider and they will be reimbursing the same amount as NYSHIP. I don’t know if this is true for everyone.
- Their mailing address is: Value Option, PO Box 1800, Latham, NY 12110. This is the only way for you to get the info to them.
- And in a testament to New York State, they do not have a fax number…yet.
- Their website says 1 out of 4 of us is going to be mentally ill this year. They want us to “Stamp Out Stigma”.
SECOND UPDATE: Another Graduate Center student contacted Value Options on their own and got this information:
- If you were seeing a mental health practitioner in 2013 that is no longer covered by ValueOptions, they will cover 12 visits at the in-network rate until 3/31/2014. BUT, you have to call them to set up a “transition benefit.”
- NYSHIP covers 15 annual outpatient visits, then 80% with $100 copay (the out of network coverage)
- All out of network coverage requires the practitioner (i.e. the dr. you’re seeing) to fill out a form on value options website called the “outpatient review form”
- Once you surpass 15 visits (or 12 visits during the transition period) you HAVE to call again to get authorization for all benefits.
[gview file=”http://opencuny.org/healthdsc/files/2014/01/NYSHIP-ValueOptions-letter.pdf”]
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