Category: Company News

UBH/Optum discontinuing Out of Network Benefits …and it doesn’t stop at behavioral health services…medical services might be equally affected. 

As of July 1, 2021 UBH/Optum has notified some providers about changes to UBH/Optum plans that apparently include, among other changes,  the decision to exclude members’ out-of-network  benefits for services located outside of the member’s plan’s  service area. Notably, a “Fully Insured” plan according to Optum is a plan wherein the insurer pays for the services  and the member is not covered by a self-funded employer plan.. The change will apply to medical and behavioral health services. Keep in mind, services are already subject to prior authorization, and this will add one more barrier to a growing number of barriers to care.

The Notice specifically calls out behavioral health exclusions for non-emergent, sub-acute  inpatient or outpatient services received at any of the following facilities:  

• Alternate Care Facility – PHP or IOP  

• Freestanding Facility – Psychiatric or Substance Use  

• Residential Treatment Facility – Psychiatric or Substance Use  

• Inpatient Rehabilitation Facility – Psychiatric or Substance Use  

While the Notice appears to have been directed to in-network (“INN”) providers, the changes we shared above  would not affect services provided by INN providers who evidently can continue to admit and treat members of  Fully Insured plans regardless of geography. Indeed, the Notice specifically advises INN  providers that they may be asked to accept Optum members who are currently at out-of-netowork (“OON”) facilities that will no longer be covered at those facilities once this change in coverage goes into effect. 

optum out of network benefits
This Optum decision could lead the way for other carriers to force providers to go in-network

Despite Optum’s couching this change in policy as a “quality and cost-share” issue, it seems  more likely to be strictly a cost-cutting measure, particularly given that the change applies only  to Fully Insured plans where Optum is “on the hook” for the cost of care, but not to self-funded  employer-plans where Optum’s role is only to serve as an administrator of claims that ultimately are  paid by the self-funded plans themselves. 

Sounds convenient, doesn’t it? It also sounds like a barrier to much needed care. 

As for providers, especially in the behavioral health space, they typically are either unable to  secure contracts with payors like Optum despite efforts to do so, or they opt to stay out-of network because they do not want to accept the lower reimbursement rates demanded by the  major payors when contracting to be an INN provider. 

We fear that Optum’s new policy is a violation of Mental Health Parity laws. While on its face the Notice appears to apply to both medical and behavioral care, in practice, there likely will be a disproportionate impact against behavioral health providers, especially residential treatment centers (“RTC’s”). 

Axis Comprehensive recently visited NATSAP and had the honor of participating in and supporting the Saving Teens annual Charity Golf Scramble.

 

substance abuse billing and saving teens Axis Supports Saving Teens

We enjoyed a perfect day of sun, fun, and golf why also supporting a great organization – SavingTeens. SavingTeens is a philanthropic organization dedicated to assisting troubled teens and their families struggling with significant emotional and behavioral challenges including anxiety, depressions, addictions and other risky behaviors.

Working in close collaboration with the therapeutic community, SavingTeens provides financial and other support to families of teens in crisis.

For more on information on the program visit them here.

Raising Money to Help Families

It was a nice trip for us – we were the only substance abuse insurance billing company at the event. The charity golf tournament was put on by some tremendously generous and heart felt folks, who did a phenomenal job raising more than $40,000 to support their programming. This means that Saving Teens will be able to help dozens of more families find the resources they need to fight addiction and other emotional issues.

We were happy to join a variety of adolescent treatment programs, educational consultants, and other substance abuse and mental health professionals to help make the even a success!

We hope to see all our new friends again next year! Count us in:)

substance abuse billing and saving teens