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ACT
in the News
ACT's
differentiation in service model from other mental health providers
generated interest that led to the following article in the
Wilmington Star:
ACT:
House-call Method Tailored to Needs of Mentally Ill Patients In Care
Facilities
What
is an ABN?
An
Advance Beneficiary Notice is notification by your health
care provider that your health insurance plan may not pay for the
services you are seeking. Not
all health care plans require this notification be made; however,
most health care providers will either provide you with this
information verbally or in writing. Health care plan rules vary.
You cannot be assured that the care you are about to receive
will be paid for because it is a type of service that is
generally covered.
The type of provider for your care, the reason you are
seeking service and the exact type of service to be received all
have an effect on health insurance payment for the service.
You have a right to be provided the best possible information
available about how your health insurance will cover services
received. If you have questions with pertinence to what proportion
of a health service bill you may personally be liable for, your
health insurance plan or your chosen health care provider should be
able to provide you with reasonably accurate information.
Is
Your Health Insurance Plan Taking Care of Your Mental Health Needs?
Health
insurance plans usually assign a deductible (an amount the insured
must pay for their care prior to health insurance benefits beginning
to pay) and a co-pay (an amount the insured must pay for each health
care appointment) for services received by covered persons.
It is important to understand both what types of services and
what type of health care providers your health plan will pay for and
how much of the bill your health plan will pay.
In addition, if your health plan is an HMO (Health
Maintenance Organization) or a PPO (Preferred Provider
Organization), you should make sure that the doctor providing your
care is enrolled as a provider in your health plan so that you are
not left with most or all of your service bill.
Most
health insurance plans provide their customers with a toll-free
number locatable on their health insurance card.
Insured persons can call this number in order to determine
what proportion of the bill they may be responsible for by providing
the customer representative with details such as 1.)
What type of service they are seeking,
2.) Why they are seeking service and
3.)The type of provider they are planning to see.
In addition, most health care providers have trained billing
personnel that can help you obtain coverage information.
Your
health insurance plan has rules for how to seek health care
services. Depending on your plan, you may have to seek all services
through your primary care physician (PCP), meaning your PCP must
write a doctor’s order for you to be able to see a specialist.
Some plans require prior approval for services through the
health plan’s case managers.
Other plans allow you to freely seek any care you feel you
need.
Not
all health plans provide for mental health parity.
This means that certain health plans discriminate against the
mental health needs of their customers by assigning higher co-pays
for these services or limiting accessibility of these services in
other ways. Mental health parity has become a “hot topic” in the
United States over the last couple of years.
There is an ever-increasing push to stop the discrimination
against providing for the community’s mental health needs.
ACT,
Inc. strives to ensure that persons in need of mental health care do
not have to forego treatment due to difficulties in paying for these
services. Our mental
health clinicians are credentialed doctoral-level clinical
psychologists and (MD) psychiatrists; the credentials of these
well-qualified doctors are accepted by most health insurance plans
that pay for mental health services. Our doctors are enrolled as providers with Blue Cross Blue
Shield, Medicare and Medicaid.
Our billing department regularly reviews other HMO and PPO
panels to determine whether we should enroll with other health care
plans. ACT, Inc. bills
insurance companies directly. We
bill the client for their health plan assigned portion of the bill
only. Payment plans and
financial hardship considerations are available by calling ACT’s
Accounts Receivable Department.
In addition, ACT fights for improved coverage of mental
health services.
In
particular, last year ACT was present in Washington, DC to fight for
amendment of title XVIII of the Social Security Act to increase the
proportion of charges Medicare recognizes for mental health services
furnished to qualified Medicare beneficiaries who reside in
congregate residences (HR 4950).
ACT finds it unfortunate that Medicare has created a
psychiatric reduction (a higher co-pay) for mental health services
received by insured persons, and tragic that Medicaid as a secondary
payer does not cover this co-pay.
The result is inaccessibility of mental health services to
many persons of lesser financial means.
Bill HR 4950 was not passed last year; instead, a government
study was initiated to determine the psychiatric reduction’s
effect on mental health accessibility. This year, HR 1522 has been sponsored by Representative Pete
Fortney to again attempt termination of Medicare’s discrimination
against mental health care. Until
the time there exists parity for mental health services, ACT will
continue to work with individuals on alternative sources of payment,
payment plans and financial hardship considerations.
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Medicare
Mental Health Modernization Act of 2001-H.R.1522
Excerpts
Gathered from Thomas, Legislative Information on the Internet
(Direct
link)
Sponsor:
Rep Stark, Fortney Pete (introduced 4/4/2001) Related Bills: S.690
Title:
To amend title XVIII of the Social Security Act to expand and
improve coverage of mental health services under the Medicare
Program.
Actions:
4/4/2001 Referred to the Committee on Ways and
Means, and in addition to the Committee on Energy and Commerce, for
a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction
of the committee concerned.
4/4/2001: Referred to House Ways and Means
4/4/2001: Referred to House Energy and Commerce
4/25/2001: Referred to the Subcommittee on Health for
a period to be subsequently determined by the Chairman.
No
amendments to the bill have been made as of 4/25/01.
The bill has 25 Co-sponsors.
SUMMARY
AS OF 4/4/2001--Introduced.
Medicare
Mental Health Modernization Act of 2001 - Amends title XVIII
(Medicare) of the Social Security Act (SSA) to provide for: (1)
elimination of the lifetime limit on inpatient mental health
services; (2) parity in treatment for outpatient mental health
services; (3) coverage of intensive residential services under
Medicare part A (Hospital Insurance) and of intensive outpatient
services under Medicare part B (Supplementary Medical Insurance);
(4) exclusion of clinical social worker services from coverage under
the Medicare skilled nursing facility prospective payment system;
and (5) coverage of marriage and family therapist services and
mental health counselor services under Medicare.
SEC.
2. FINDINGS.
The Congress finds the following:
(1) Older
people have the highest rate of suicide of any population in the
United States, and the suicide rate of that population increases
with age, with individuals 65 and older accounting for 20 percent of
all suicide deaths in the United States, while comprising only 13
percent of the population of the United States.
(2)
Disability due to mental illness in individuals over 65 years old
will become a major public health problem in the near future because
of demographic changes. In particular, dementia, depression,
schizophrenia, among other conditions, will all present special
problems for this age group.
(3) Major
depression is strikingly prevalent among older people, with between
8 and 20 percent of older people
in community studies and up to 37 percent of those seen in primary
care settings experiencing symptoms of depression.
(4) Almost 20
percent of the population of individuals age 55 and older,
experience specific mental disorders that are not part of normal
aging.
(5)
Unrecognized and untreated depression, Alzheimer's disease, anxiety,
late-life schizophrenia, and other mental conditions can be severely
impairing and may even be fatal.
(6) Substance
abuse, particularly the abuse of alcohol and prescription drugs,
among adults 65 and older is one of the fastest growing health
problems in the United States, with 17 percent of this age group
suffering from addiction or substance abuse. While addiction often
goes undetected and untreated among older adults, aging and
disability makes the body more vulnerable to the effects of alcohol
and drugs, further exacerbating other age-related health problems.
Medicare coverage for addiction treatment of the elderly needs to
recognize these special vulnerabilities.
(7) The
disabled are another population receiving inadequate mental health
care through Medicare. According to the Health Care Financing
Administration, Medicare is the primary health care coverage for the
5,000,000 non-elderly, disabled people on Social Security Disability
Insurance. Up to 40 percent of these individuals have a diagnosis of
mental illness.
(8) The
current Medicare benefit structure discriminates against the
millions of Americans who suffer from mental illness and maintains
an outdated bias toward institutionally based service delivery.
According to the report of the Surgeon General on mental health for
1999, intensive outpatient services, such as psychiatric
rehabilitation and assertive community treatment, represent
state-of-the-art mental health services. These evidence-based
community support services help people with psychiatric disabilities
improve their ability to function in the community and reduce
hospitalization rates by 30 to 60 percent, even for people with the
most severe mental illnesses.
 Special
Events
Employment Anniversaries
Dr. Barry
Moore is celebrating his 5-year anniversary with ACT June 15
Mrs. Doris
Moore is celebrating her 5-year anniversary with ACT June 15
Dr. Pete
Boyle is celebrating his 3-year anniversary with ACT May 6
Mrs. Ann
Porter is celebrating her 2-year anniversary with ACT May 3
Dr. Manijeh
Boustani is celebrating her 2-year anniversary with ACT June 4
Dr. Austin
Chandler is celebrating her 1-year anniversary with ACT May 1
Dr.
Gretchen Belovicz is celebrating her 1-year anniversary with ACT May
1
Dr. Sara
Schneidmiller is celebrating her 1-year anniversary with ACT May 1
Dr. Smeeta
Souza-Roy is celebrating her 1-year anniversary with ACT May 1
Dr.
Victoria Williams is celebrating her 1-year anniversary with ACT May
1
Mr. Joe
Dreiling is celebrating his 1-year anniversary with ACT June 12
Dr. Tom
Goodwin is celebrating his 1-year anniversary with ACT June 20
Dr. Gem
Moore is celebrating her 1-year anniversary with ACT June 21
Happy
Birthday To You!!
ACT is 5
years old June 15
Mrs.
Cynthia Edens May 23
Dr. Manijeh
Boustani May 26
Dr. Bryan
Patterson June 5
Dr. Jim Cox
June 14
Dr. Sara
Schneidmiller June 14
Mr. Bill
Aiman June 21
Dr. Sandra
Story June 22
Dr. Peggy
Love-Clark June 25
Dr. Gem
Moore June 30
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