Dec 122014

Here is one student’s account of how she was able to get reimbursed by ValueOptions and even get some interest on it due to late payment. While the fact that anyone has to go to such lengths to ensure that they receive their healthcare benefits is itself absurd, but I wanted to post it here so you have some steps you can take to advocate for yourself if you are having issues with getting mental healthcare reimbursement. Student’s account below. TL;DR: if your claim is denied, keep copies and records of all forms, call them to get an appeal started (keeping spreadsheet of who you talk to and when),  send them a copy of the  1) form and receipt again, 2) the spreadsheet with the dates, times, and notes from the calls, 3) a letter explaining what they did wrong with all of the claim numbers for their reference (from the Value Options Members page), and “a firmly worded expectation that [you] expect them to resolve it”:

Here’s what I have done with Value Options:

This applies to the period when they were requiring authorizations. Fortunately, as of 10/1/14, they no longer require these authorizations on file.  I will not comment on how outrageous I think some of their requests are, only what I’ve done to get reimbursed from them.

First, I downloaded the form and filled in all of the permanent information (address, member number, etc). Then, I went to Staples and paid for the color printing for 36 of these forms (3 years worth of forms, $15.12). I bring 6 forms at a time to my therapist. She signs them but does not date them (I put a post it over the date for her).

I keep these and fill in the relevant information every month (i.e., dates, number of sessions, etc.) and then I sign them. My therapist gives me a monthly receipt. I scan a this receipt and the claims form. I send them the original claims form (red ink, black type) and the copy of the receipt. I then keep the original receipt and a copy of the claims form.

Often they lose the claim form, or reject it for a non-reason. One month later (or when the rejection letter comes), I call them to get an appeal started. This step is crucial because they have timelines for how long after service a claim can be reimbursed and how long you have to appeal. When I call, I log it into an Excel spreadsheet with the dates and times of when I called, who I spoke to, and basic notes about what was discussed.

For a while, they were rejecting my claims because I had no claim on file. I had my therapist fill out an authorization and then I faxed it to them after every 10 sessions. They then applied the sessions to my account. Problem is they were constantly trying to say that I didn’t have available sessions, and they kept applying the sessions out of order (i.e., September before May so that I wouldn’t have any available sessions for the May dates, etc.).

For every rejection, what worked for me was sending a copy of the form and receipt AGAIN, the spreadsheet with the dates, times, and notes from the calls, a letter explaining exactly what they did wrong with all of the claim numbers for their reference (which I retrieve from the Value Options Members page), and a firmly worded expectation that I expect them to resolve it. This has worked for every appeal, usually with some kind of letter from management stating that if I’ve hired anyone to act on my behalf, I have to inform them.

Ultimately, I think that the letter and the copies of the forms is what has gotten their attention (the call log is probably over-the-top). I think that once any other paper comes in it has to go to management, and then someone’s day has been interrupted to deal with something out of the ordinary, and I think that has a lot to do with getting a reimbursement, though it has taken up to 6 months and two letter to get the reimbursement for some of them.

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