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Sunday, September 22, 2013
Martha Pillow was shaken last week when she first learned that her insurance for mental health services is about to take a step in the direction of managed care.
“I didn’t even know anything about it,” the 62-year-old former librarian from Roanoke County told me. “No one is really prepared for this. I panicked the day I found out about it.”
She learned about the impending change through an email from the National Alliance on Mental Illness of Virginia, not from state officials or from the company that will be administering her insurance, a fact that boosted her anxiety level.
Starting Dec. 1, Magellan Health Services of Connecticut will handle behavioral health care coverage for adults and children insured through the government-operated Medicaid and FAMIS programs.
Magellan is holding six forums across the state to explain the upcoming changes to insured individuals. The Roanoke event will be 4-6 p.m. Wednesday at the Holiday Inn Roanoke Tanglewood on Starkey Road. A separate meeting on credentialing for health care providers is scheduled for 1-3 p.m. Those planning to attend are asked, but not required, to register at www.surveymonkey.com/s/VA-Forums.
Magellan representatives will explain the transition and take questions. Pillow is worried about whether her medications will be covered.
“And I’m concerned about changing doctors,” she said. “I have a lot of questions. I love my psychiatrist and I do not want to switch.”
Mira Signer, executive director of NAMI Virginia, said the most common concerns she is hearing are from people who want to keep their current provider and those worried about having to get prior approval for care. She hopes the forum will help to alleviate some of those fears.
“We’re hoping that it’s pretty nuts and bolts,” she said. “It would be nice if they could reassure people.”
Managed care is already in place for other Medicaid services such as medical care, in-patient psychiatric and clinical services. The Magellan contract will cover case management, crisis intervention, therapy, day treatment and other community-based services. The goal is to provide better health services at less cost. Signer hopes the change will result in quality assurance measures and better oversight for individuals who have complex medical and mental health challenges.
“In terms of truly having coordinated care, that’s a big potential positive if it’s done well,” she said.
There’s also the possibility that new services could be covered by insurance, such as specialized supportive housing and peer support specialists, people who have a mental illness and use their experience to help others navigate what can be a confusing array of programs. On the flip side, Signer is wary about the potential for red tape and confusion over how to obtain services or challenge the denial of claims. Strict and convoluted rules for obtaining prior authorization for services don’t work well for individuals in the midst of a mental health crisis.
“There is still tremendous potential for things to go wrong,” she said.
State leaders have put in place some consumer protections. For one thing, managed care is being phased in. Magellan initially will handle administrative functions such as billing, provider certification and management of claims. In a few years, it may move to a system in which the company would be paid a flat fee per person served, the point at which new restrictions could crop up.
Magellan representatives have sought out advocacy groups like NAMI for feedback on written materials that explain the changes, a good sign. Another hopeful indicator is that the company plans to host a second set of forums in November as the deadline for change draws near. Perhaps the second set of meetings will include evening and weekend hours to make the events more accessible to individuals and their families.
It’s in everyone’s interest for this transition to be a successful one. A good start will be to make sure those affected have an adequate chance to ask questions and get answers up front.
Nuckols is editorial page editor of The Roanoke Times.
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