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On June 6th, 2019, Anthem, Inc. announced that they are in the definitive stages to acquire Beacon Health Options, Beacon currently serves more than 36 million individuals across all 50 states, and 3 million of those under comprehensive risk-based behavioral programs.

“Our member-focused, integrated clinical care model helps individuals and their families cope with their physical and behavioral health challenges. Together, we will expand access and enhance the quality of care for our mutual members. I am proud of the talented and committed team at Beacon, and we look forward to our future with Anthem.”Russell C.Petrella, Ph.D., Beacon Health Options President and CEO

Anthem didn’t disclose a price it is paying Bain Capital Private Equity and Diamond Castle Holdings for Beacon Health, which is privately held. The acquisition is expected to close in the fourth quarter of 2019. However, this is a great opportunity for Anthem to utilizing Beacon Health Options, already stellar business model, not to forget they are the country’s largest independently held behavioral health provider.

“As Anthem works to improve lives, simplify healthcare and serve as an innovative and valuable partner, we’re focused on providing solutions that address the needs of the whole person,” -Gail K. Boudreaux, President and CEO, Anthem

The acquisition will offer the opportunity to combine both successful business models to diversify the health services and deliver market-leading integrated solutions. Progressing towards a stronger portfolio of specialized services, improved clinical expertise, and ability to offer broader provider networks and establishing positive relationships.

“We are excited to partner with Anthem to serve the behavioral health needs of more than 60 million Americans,” –Russell C. Petrella, Ph.D., Beacon Health Options President and CEO

Once the acquisition is complete Beacon, combined with Anthem’s behavioral health business, will operate as an integrated team within Anthem’s Diversified Business Group. Russell C. Petrella, Ph.D., Beacon Health Options President and CEO, as well as other key members of Beacon’s senior team, will join Anthem’s Diversified Business Group to lead the efforts to offer innovative behavioral health solutions and further expand this business.

“With an extensive track record in behavioral health, Beacon fits well with our strategy to better manage the needs of populations with chronic and complex conditions, and deliver integrated whole health solutions. Together with Beacon, we will enhance our capabilities to serve state partners, health plans and employer groups as they seek to address consumer behavioral health needs.” -Gail K. Boudreaux, President and CEO, Anthem

We are excited and believe this is very significant as more insurers are working on addressing the determinants of care for mental illness that fall outside of the traditional medical care. One out of every five adults suffers from mental illness, and is only increasing, according to the National Institute of Mental Health.

What are your thoughts on this acquisition? Is this good or bad, why so?

Now that it’s officially the “Holiday Season”, if you’re like most people I know, as much as we would like to be in good spirits, we all know the stress it can cause. It doesn’t make it any better when there are those already dealing with a mental health illness. But it doesn’t have to be so bad after all, especially if food is involved, right?

We know it’s fall time when the weather gets cooler, the colors outside change, and of course we begin to hear Christmas music everywhere we go, even if Halloween was just two days ago. The joyous anticipation towards the holidays is what most just can’t wait for all year long.

Grandma’s sweet smelling baked goods, cooked to perfection turkey, and all the sides one can ask for while enjoying it all with your loved ones and friends. Making your plate look like Splash Mountain at Disneyland, then knowingly preparing for the ultimate food coma that will inhibit your body for at least two hours on the couch while watching football or family movies.

Ahhh yes its time to eat everything in sight now, and start fresh all over again by going to the gym on January 1st. That’s generally the plan, right?

Well, what if I told you, you can incorporate five certain foods during the holidays that can actually help with your mental health, would you eat it? The mental health benefits of certain holiday foods go beyond the food memories that make you feel good. The nutrients in these five foods can deliver a solid boost to your mood, which is something we can all use during the stressful holiday season.

1. Pumpkin

This may be the most known holiday food used, but did you know that pumpkin contains minerals that boost brain function?

Pumpkin contains Lutein and Zeaxanthin, which are both excellent nutrients for boosting memory recall in both younger and older adults.

The pumpkin seeds contain the amino acid Tryptophan and help your brain produce serotonin, a chemical known to boost your mood and give you an overall content feeling. So eat as much pumpkin pie as you can, well in moderation I guess.

2. Cinnamon 

When I think of Thanksgiving or Christmas, my first thought is the smell of cinnamon sticks as I walk into my Aunts house I visit every year.

Cinnamon adds warmth to the flavor in teas, cider, oatmeal, bread, baked fruit and veggies, and more. Try making cinnamon roasted almonds, cinnamon rolls which are always a kid favorite, or you can get your healthy on and try making a cinnamon spiced pumpkin hummus, and incorporate two great holiday foods.

But the benefits are even better by helping in stimulating your brain, and also helps regulate blood sugar, which contributes to an overall steady mood.

3. Turmeric

Turmeric is considered a wonder spice for so many health conditions including reducing the symptoms of depression. Tumeric has powerful antioxidant and anti-inflammatory properties also which is great for your overall well being.

There are many ways you can use Tumeric. Try it by spicing up your chicken or turkey dish, or add it to your soups, or just simply add it to your coffee in the morning. Don’t worry, your body will thank you later. If you do use Tumeric in your dishes, remember that although it does taste very delicious, a little bit goes a long way.

4. Apples

You can find apples in your local store all year long, but September and October are the best months to get apples. Over the past several years, nutrition research has focused on the effects of apple consumption and its relationship to providing protective neurological benefits.

Registered Dietitian Jenn Fillenworth, MS, RD, says, “Since apples have a high phytochemical profile, they are excellent at preventing DNA damage, regulating hormones, and reducing oxidative damage,” she explains. “All of these things are directly related to supporting good mental health.”

You can use apples in any salad, or a salsa dip, also try baking some apple chips in the oven to eat with your apple salsa dip.

5. Acorn squash

Acorn squash is a small type of winter squash with a light yet slightly sweet flavor. Acorn squash is one of the most nutrient-dense squash varieties and contains higher amounts of antioxidants than other squash in general. It contains magnesium, which is an important nutrient for helping with depression and anxiety.

“A recent study shows that increasing magnesium in the diet may lead to a significant decrease in symptoms of depression and anxiety regardless of age or severity of their depression,” -Registered Dietitian Jenn Fillenworth, MS, RD

Try stuffing it with some cinnamon and fruits such as apples or peaches, or for your meat lovers try stuffing some of your favorite meats. I guarantee it will taste great while helping to decrease anxiety and depression.

I hope this was helpful and gives you some ideas for taking a healthy choice dish for your next family holiday party. With the well-known stressors that can be triggered during the holidays, we can all use anything and everything that can help remedy the chaos during this busy yet wonderful holiday season.

 

 

Did you know that nearly one out of every five Americans had a mental illness last year? Denying coverage is now being looked at deeper than just a financial issue, as some see it as a human rights issue.

Families are suffering from the strict system placed on behavioral health insurance processes. A system that fails the needs of people who need it the most, because of not meeting insurance company’s, medical necessity, clause.

Without a reasonable doubt, this is more than a concern for so many Americans who suffer from behavioral health illnesses and can’t seem to get the adequate treatment needed to overcome this difficult roadblock.

A psychiatrist once said,

“Before I decided to specialize in psychiatry, I assumed a person in need of mental health care would have the same access to treatment one has for medical conditions like kidney stones, pneumonia or seizures. Instead, mental health patients and their providers face a mountain of bureaucratic obstacles that other patients are spared.”

Imagine being a doctor, and having to tell someone or even a child who desperately needs treatment, that they aren’t considered depressed enough, or their presenting conditions do not meet the most critical states of mental illness in order to be treated.

With adolescent mental health illnesses on the rise, this has to be one of the most ignored issues that we face in America today. According to the new report, diagnoses of “Major Depressive Disorder”,  have risen to over 30 percent since 2013, and now affects an estimated 9 million commercially insured Americans.

Teen depression rates are increasing so rapidly, if we don’t figure out a better solution, we will be headed for an array of consequences. The Centers for Disease Control and Prevention estimates there were 72,000 deaths from opioid overdoses last year and more than 43,000 suicides reported in 2017.

Nowadays the requirement to even be admitted into a psychiatric facility is set so high, it can be very frustrating when attempting to get prior authorization for treatment. Even if patients have just attempted suicide, shockingly many insurers still require prior authorization by phone before they can step foot inside of the facility.

“Even in spite of the fact that we’re in the midst of the biggest public health crisis of our time of overdose and suicide, we as a nation have yet to come to grips with this in the way that it needs to be,” – Former congressman and mental health care advocate Patrick Kennedy. 

For any other medical hospitalization, nothing is really required and the insurers trust the judgment of the providers. Not the same for psychiatric hospitalizations and treatment centers. In the U.S., denials for mental health care occur three times as frequently as denials for general medical care.

The process of finding and funding adequate mental health treatment is a very daunting task, and most times insurers will simply deny treatment initially knowing that most people are going through so much that will won’t challenge denials of care, leaving them feeling lost and confused and only adds to the stress they are already dealing with.

It’s time to make mental health illness a priority in not only fighting the stigma but also the discrimination set forth from the insurance companies. This system continues to get worse and totally does everything they can to stop treating those who need it, simply based on the fact that they are not considered depressed enough, or suicidal enough to please their extreme criteria. Ask yourself, why isn’t mental health illnesses being looked at as serious as cancer, diabetes, or cardiovascular diseases?

It’s quite frustrating when just 10 years ago, a law passed called the  Mental Health Parity and Addiction Equity Act, also known as the Federal Parity Law. The law requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than they cover illnesses of the body.

“There are still tons of roadblocks on the policy side and, frankly, in spite of the fact Congress thinks they’ve appropriated some gargantuan amount of money, it still represents less than one-fifth of what we were spending on HIV/AIDS during the AIDS crisis when we were losing far fewer people than we’re currently losing today,” – Patrick Kennedy

In a recent study conducted by a private research company and Georgetown University, researchers found the following listed below.

  • Insurers regularly denied coverage to people with pre-existing mental or substance use conditions;
  • Insurers imposed a 20 to 50 percent increase in premiums for people with a history of mental health or substance use conditions;
  • Insurers offered superficial coverage that did not meet essential needs; and
  • Insurers actively created barriers and limited access to mental health and substance use treatment.

The only way we can see any change is by standing up and speaking out on unjust insurance denials and registering a complaint with your health plan. The more we do this, we can help pressure elected officials, insurance commissioners, and the attorneys general to enforce federal and state parity laws in favor of the patients who need the attention and treatment their insurance plan should be covering.

Nothing will ever change if we don’t speak up and hold insurance companies accountable. We must demand equality for those with mental health and addiction challenges. We cannot stand idly by while insurance companies break the law, at the expense of American families.

Help for Mental Illnesses. Get Immediate Help. If you are in crisis and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (1-800-273-8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week.

Have questions or need help with insurance claims and or denials, we are always here to answer or help in anyway possible.

Frequently Asked Services Questions

 

Verification of Benefits

What is the response time when a facility submits a Verification of Benefits to Axis?

Axis has a team consisting of 9 Claims Representatives that also verify benefits for our facility. As soon as we receive a Verification of Benefits, within minutes a claims representative will be on the phone with the insurance company. We believe in very thorough verification of benefits processes. We will cross reference all information to ensure accuracy before returning the Verification of Benefits to your facility.

On average a thorough Verification of Benefits will take about 45 minutes or less.

What can my facility expect when Axis verifies benefits for a patient?

You can expect the Axis to take every pre-caution to ensure accuracy of benefits for every level of care. We understand how paramount the Verification of Benefits process is to the entirety of billing processes. If the Verification of benefits its not done thoroughly it will have a domino affect for the patients authorizations and billing processes. We not only give you the benefits that were quoted to the Axis team, but we also provide a benefit summary which is more comprehensive.

We also provide additional information on the insurance carrier or policy and let you know what our experience has been with the insurance carrier or the specific policy. We want to make sure you understand the benefits to the fullest in order to best help your patients.

Utilization Review / Authorizations

What is a Utilization Review / Authorization?

There are 2 components of Authorizations. The first is the Pre-authorization, this process is typically done using a very specific format which Axis has refined over the years to cater to the insurance companies needs. When a patient arrives at your facility we request that your clinician fills out the entirety of the pre authorization from which we provide to you.

Once this is complete you will submit the form to the Axis Authorization team and we take it from there. As soon as we receive the authorization from the insurance company, we then notify the representatives at your facility to let them know when we will need a Utilization Review to obtain further authorization.

The Utilization Review is done anywhere from every 3 days up to being on a monthly basis. This is dependent on the level of care in which the patient is at as well as the complexity of each case. We also supply your facility with a Utilization Review template in which your clinicians will fill out and again submit to the Axis Authorizations Team. The authorizations team will then contact the insurance carrier using the provided information and obtain further authorization.

What are the benefits of having your team manage authorizations for our facility?

The Axis authorizations team is comprised of clinicians who are specially trained to work with insurance carriers. They speak the language of the insurance companies and spend countless hours researching and staying up on the changes in the substance abuse and mental health field. They also are very familiar with the medical necessity criteria for each insurance carrier.

This allows the authorizations team to advocate  for your patients and maximize authorizations for your patients.

The Axis authorizations team does not take no for an answer when it comes to helping a patient receive treatment. We have specific policies and procedures that the authorizations team follows to manage any denials and have set a new standard of overturning denials. Above this all of the individuals in our authorizations department are extremely passionate about helping individuals receive the treatment they need.

Claims Processing and Management

How long does it take to receive payments after submitting claims?

The turn around time for claims to be processed and paid is highly dependent on the insurance carrier. Axis made an analysis for the past 6 months and found that the average time it takes to receive payment on a claim is roughly 45 days from the time it is submitted to the insurance company.

Does Axis help with appeals and denials of claims?

Yes, Axis manages all aspects of claims processing including denials management. We have very defined processes for appeals and managing denials. Similar to the authorizations team, we do not accept denials lightly. We  appeal the denials using specific denial management tools to ensure that we are fighting the denial until there is some type of determination. Our staff is specially trained in managing denials and understand the insurance processes thoroughly.

This allows us to successfully overturn many denials and receive payment on claims.

Axis is follows up on all claims every other week. This allows us to catch any problems with claims processing in a very swift manner. While many 3rd party billing companies submit claims and wait for remittance from the health insurance carrier, which can be 30-60 days from the time a claim is submitted, we take a very proactive approach to the claims management processes.

By utilizing our expertise and our diligent approach we will know if a denial happens before any remittance is submitted to your facility as well as have the ability to manage claims on our end without needing to contact your facility to assist with these processes.