An Important Message About Our Behavioral/Mental Health Benefits
March 10, 2020 / By Susan Latessa, UNY Director of Human Resources/Benefits
Editor's Note: The following letter concerning changes in the way claims are processed for our behavioral/mental health services was sent to insured employees from Susan Latessa, UNY Director of Human Resources/Benefits on Monday March 9.
Dear UNY Medical Plan Participants,
It has been brought to our attention that there is a need for some clarity around a recent change in who processes claims for our behavioral/mental health services.
Wespath made a change to the 2020 health plans effective January 1, 2020 by changing the claims administrator for the behavioral/mental health inpatient and outpatient services from Optum (UBH) to Blue Cross Blue Shield IL (BCBSIL).
If you or a family member are receiving or are in need of behavioral/mental health inpatient and outpatient services, you need to give your new Blue Cross Blue Shield medical id card to your provider, and they should be submitting the claims to Blue Cross Blue Shield IL.
If you have had claims denied with the reason: “not an eligible participant,” it is most likely due to your provider not being aware of the change and submitting the claim(s) to Optum. Your provider simply needs to resubmit the claim(s) to BCBSIL.
If your provider is not in network (does not accept/participate) with BCBSIL, you may need to submit your claim yourself. The claim form needed to submit your own claims is on the Conference website. If services you have rendered have been performed by more than one Dr. or therapist, each claim must be submitted separately with a claim form for each one. The behavioral health benefits remain the same—with a $15 co-payment for outpatient office visits for those in the B1000 and 20% coinsurance (no deductible) for those in the C2000. The same benefits apply whether your provider is in the BCBSIL network or not.
Prior to January 1, 2020, Optum/UBH had provided both EAP Counseling and processed claims for behavioral/mental health inpatient and outpatient services for those needing ongoing behavioral/mental health services. Optum continues to provide the EAP services, though the number has changed to 866-881-6800, which can be found on your BCBS medical ID card. It is only the claims administration for ongoing inpatient and outpatient services that were transitioned over to BCBSIL.
Wespath is in process of sending a similar communication, as well as offering tips for differentiating between EAP and ongoing mental/behavioral health services. If you have questions or need assistance, please contact Julie Valeski (email@example.com) or me for guidance. Either one of us can guide you on what you need to do.