The Empire Plan Mental Health and Substance Abuse Program (MHSA) is now administered by OptumHealth Behavioral Solutions. While your benefits will not change, the provider network is different. Therefore, the status of your provider may change.
To find out if your provider is currently in the OptumHealth network, you can check your provider’s network status at www.EmpirePlanMHSA2009.com or call (877) 769-7447, press Option 3 then select the 2009 MHSA option for OptumHealth. If you have impaired hearing, call (800) 855-2881 (TTY).
If you are in care with an MHSA provider participating in the ValueOptions network, you can continue to receive the network level of benefits through March 31, 2009—under the “transition of care” benefit—even if your provider is not in the OptumHealth network. If your treatment is not completed or your provider does not join the OptumHealth network by March 31, your benefits for medically necessary care will be substantially reduced unless you switch to an OptumHealth network provider.
Following are some of the frequently asked questions:
Q: What is the transition of care benefit?
A: The transition of care benefit allows you to continue to receive network benefits even if your provider has not joined the OptumHealth network as of Jan. 1. All levels of care are covered under the transition of care benefit.
Q: How do I access my transition of care benefit?
A: You do not need to call or complete any forms to access the transition of care benefit. If you received network benefits between July 1 and Dec. 31, 2008, you will automatically be given the transition of care benefit through March 31 for services received from the same provider, even if that provider is not in the OptumHealth network. Please note that these benefits apply to covered services received between Jan. 1 and March 31.
Q: If I already have certification from ValueOptions and will be using the transition of care benefit, will my certification from ValueOptions transfer?
A: Yes. You do not have to call OptumHealth.
Q: I just checked the Web site and my provider is not in the OptumHealth network. What are my options?
A: The transition of care benefits allows you to receive network benefits, even if the provider you were seeing in 2008 is not part of the OptumHealth network. When the transition period ends March 31, you must use an OptumHealth network provider to receive the highest level of benefits. You may call us at any time to access network benefits. If you continue treatment with your non-network provider after March 31, you will have higher out-of-pocket costs.
Q: How can my provider become part of the OptumHealth network?
A: If your provider is not currently in the OptumHealth network, you may nominate your provider by calling
(877) 769-7447 or your provider may call OptumHealth directly at the same number.
Q: My dependent may be receiving inpatient treatment at the end of the year and I’m worried about her care. How will it be handled?
A: ValueOptions will continue to monitor the care of anyone who was in a hospital or residential treatment facility on Dec. 31, 2008, and remained confined on Jan. 1.
Once discharge occurs to another facility or another level of care, all treatment will be managed by OptumHealth.
— Doreen Bango, Manager, UUP Member Benefits and Services