Feb 172014
 

When NYSHIP made an abrupt change of course, switching Mental Health and Substance Abuse (MHSA) carriers after stating there would be no change and not notifying its enrollees until days after the change had gone into effect, many GC students were left trying to figure out what this change means for them… and without any warning to make necessary investigations or plans.  Over a month later, there is still a lack of clear and concise information from NYSHIP or the new carrier, Value Options, about the services and the transition from OptumHealth.  NYSHIP enrollees who were receiving MHSA services at the end of 2013 should have received a letter detailing the transition process, but with the amount of buzz and concern I’m hearing about this change, it’s obvious that there are still many questions left to be answered.

So I am asking for you to share your experiences/frustrations/questions/concerns with the new carrier and the transition so that we can create a helpful conversation that hopefully will fill in those gaps.  You can post a comment below in response to this post or submit a message via the Health & Wellness site’s contact form [Please check “submission for blog” as the subject of your message.  I receive this form via email and I can update the post to include your message.]   If you submit a message via the contact form, your submission and its inclusion in this post will be anonymous unless you specify otherwise in your message.  Feel free to provide any sort of identifying information for inclusion if that is your wish (e.g. “DSC Representative” or “J.P.”).  Furthermore, to ensure your privacy, both your name and your email address are optional sections on the contact form.

Thanks for your help!

Delays in Reimbursements: “They keep losing the forms that are sent to them”

I have been seeing two out-of-network providers since October, and since the switch to ValueOptions I have run into numerous difficulties in getting reimbursed. As I am paying my providers upfront, it is causing considerable financial hardship to not have these reimbursements handled in a timely manner. At this point, ValueOptions owes me $5,000 for services received between January and March. The most irritating part of this is that the number one cause for the delay is that ValueOptions keeps on loosing the forms that are sent to them. I have had to submit claim forms 3 or 4 times before they acknowledge receipt, and my providers have had to submit authorization requests 2 to 3 times. This happens even when forms are sent via fax AND snail mail. In addition, the forms have been rejected for insignificant issues, such as the diagnosis code needing to be five digits when the official code is only four digits (they wouldn’t process it until my provider added a zero onto the code and I resubmitted it). Of the one claim that they have officially processed and approved, I still haven’t received the actual reimbursement – despite the claim being approved over a month ago. And apparently they cannot do anything to locate the check until it has been issued for two months…. Our old provider, while not perfect, was much more responsive, processed claims more quickly, and NEVER lost paperwork. I am extremely disappointed in the decision to switch providers and the lack of communication regarding the switch.

 

Frustrations with Finding a New Provider: “In theory we have mental health coverage, but effectively we do not”

My current provider, who I have been seeing for over 3 years, is on OptumHealth and is NOT on Value Options. Her office will not switch to accepting Value Options, so I need to find a provider given the financial burden of paying the out-of-network rate.

I have searched and have been unable to find a provider on Value Options who is accepting new patients, is within a reasonable commute from the Graduate Center, home, work, and the campus where I teach.

I understand that the coverage itself has not changed ($10 co-pay, 80/20 benefits, 15 in-network visits per year, etc.) but I am extremely frustrated by this change. In theory we still have mental health coverage, but effectively we do not given the limited number of providers on Value Options who are actually accepting new patients.

My options now are to end the treatment and established rapport that I have with my provider or pay the out-of-network rate (which is not feasible given my limited budget).

With the 80/20 coverage for out-of-network providers, even with the discounted rate that my current provider offered, my monthly out-of-pocket expenses for mental health coverage will increase by 140%. This is unacceptable.

I am very disappointed at this change and sincerely hope that the Graduate Center and administration had the best interests of students’ health in mind when this change was implemented.

 

Providers not Getting Reimbursed in a Timely Manner 

The psychologist I see, who is on Optum but not Value Options, sent in paperwork about our sessions in January, and she has not received compensation or information back yet–every time she calls, they tell her about some new form she has to fill out for the process that they didn’t mention before. She tells me that Value Options had a bad reputation in the past among mental health providers, which is why many decided not stay on it; this instance only seems to reaffirm a troubling lack of transparency in their provider process, which rebounds on students when they cannot find a reasonable enough number of providers who both take the insurance and are taking on new patients.

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