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As a HealthSelectSM participant, you have access to resources to help you take care of both your physical and mental health. In this presentation, you will learn about updates being made to how HealthSelect of Texas® and Consumer Directed HealthSelectSM participants receive mental health care.
What is changing?
Effective September 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will manage mental health benefits for all HealthSelectparticipants, replacing Magellan Healthcare®. • Most Magellan providers will
also be in the HealthSelect network
• 10,000 new mental health providers added
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Presentation Notes
Effective September 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will manage mental health benefits for all HealthSelect participants, replacing Magellan Healthcare®. This means that BCBSTX will handle your benefits and claims processing for mental health and substance use services. About 95% of the providers who were in-network for Magellan will also be in the HealthSelect network. As a HealthSelect participant, you will also have access to the roughly 10,000 additional providers in the HealthSelect network who were not previously contracted with Magellan. This more than doubles the number of mental health providers in the network that are available to you and your family. HealthSelect Out-of-StateSM and HeathSelect SecondarySM mental health benefits are already managed by BCBSTX, so will not experience any changes as a result of this transition. You do not need to do anything if you are enrolled in either the HealthSelect Out-of-State plan or HealthSelect Secondary plan.
Why is the plan making this change?
Streamlined coverage and claims processing • One company to call for medical and
mental health benefits questions
• One website to visit to view all claims
www.healthselectoftexas.com
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With this change, BCBSTX can better help you take care of your physical and mental health. Now, all HealthSelect participants will have just one company to call for medical and mental health benefits questions, and one website to visit to view claims by signing in to Blue Access for MembersSM at www.healthselectoftexas.com.
Mental health benefits will not change. • No change to deductibles,
copays, coinsurance
• No change to eligible services for mental health and substance use
Do any of my mental health benefits change?
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Your benefits will not change as a result of this transition. The deductibles, copays, coinsurance and eligible services for mental health and substance use remain the same.
Providers continue to be addedCheck if a provider is in the HealthSelect network in Provider Finder® or call a BCBSTX Personal Health Assistant
Can I keep my current mental health provider?
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As I mentioned earlier, most providers who were in-network for Magellan will also be in the HealthSelect network, and we’re adding more than 10,000 new providers who were not in the Magellan network. Mental health providers will continue to be added to the HealthSelect network over the coming months, so check Provider Finder® or call a BCBSTX Personal Health Assistant for the most up-to-date information on network status. If you are currently looking for a mental health provider, make sure the provider you choose will be in the new HealthSelect network on September 1, or you could be paying out-of-network costs, which will be higher. To check if a provider is in the HealthSelect network, log in to Blue Access for MembersSM. Click “Doctors & Hospitals,” then “Find a Doctor.” This will redirect you to Provider Finder, where you can search for the most up-to-date information on in-network mental health providers and facilities, including the anticipated termination dates for providers who are not currently in the new HealthSelect network, and effective dates for new providers being added to the network. If you or your covered dependent(s) are currently seeing a mental health provider who will remain in-network, you can continue to see your in-network mental health provider at the same benefits and coverage you have now. You don’t need to do anything.
• If your current Magellan mental health provider will no longer be in the HealthSelect network after September 1, your HealthSelect plan offers a 90-day grace period
• Select a new provider to get in-network benefits
What if my provider is no longer in-network?
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If you are enrolled in HealthSelect of Texas or Consumer Directed HealthSelect and you or a covered dependent are currently seeing a mental health provider who is in the current network for outpatient office visits like counseling, therapy or psychiatric care, and your provider will no longer be in the HealthSelect network after September 1, your HealthSelect plan offers an automatic 90-day grace period. This means that from September 1, 2020, through November 30, 2020, your claims for covered mental health services with the out-of-network provider will continue to be paid at the in-network benefit level. You do not have to request this grace period; you get it automatically. Again, to get the most of your benefits and keep your out-of-pocket costs lower, you are encouraged to find an in-network provider during this 90-day grace period. After November 30, 2020, if you continue to see the out-of-network mental health provider, your benefits will be processed at the out-of-network benefit level. If there is a reason you need to continue to receive care from the out-of-network provider beyond November 30, you should complete a Mental Health Transition of Care request form. You can download the form from the “Medical Benefits” tab at www.healthselectoftexas.com. To approve your request, it may be necessary for BCBSTX to request Call a BCBSTX Personal Health Assistant if you have questions or need help finding an in-network provider.
What if my provider is no longer in-network?
Prior authorizations on file with Magellan that extend beyond September 1, 2020, will transfer to BCBSTX.• Claims for covered services with the
out-of-network provider will continue to be paid at the in-network benefit level through November 30, 2020, or the authorization end date, whichever comes first
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Any prior authorizations on file with Magellan that extend beyond September 1, 2020, will transfer to BCBSTX. This means that your claims for covered services with an out-of-network mental health provider will continue to be paid at the in-network benefit level through November 30, 2020, or the authorization end date, whichever comes first. You do not have to request this extension—it’s automatic. If you or your provider think you need to continue treatment longer than the initially approved transition of care period with a provider who is no longer in the network, you should complete a Mental Health Transition of Care request form. You can download the form from the “Medical Benefits” tab at www.healthselectoftexas.com. To approve your request, it may be necessary for BCBSTX to request information from your provider(s). Transition of care benefits for covered services will be determined by BCBSTX. Of course, if you would still prefer to see your current mental health provider, even if he or she is not in-network, you may do so and still get coverage, but you will pay more for the services you get because they will be covered at the out-of-network benefit level.
If your provider is not in the HealthSelect network, you can submit a mental health provider nomination form.
Can I nominate an out-of-network provider?
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If your provider has not joined the HealthSelect network, you can submit a mental health provider nomination form to request that they join. You can find the form on the HealthSelect website on the “Publications and Forms” page. Please keep in mind: Your recommendation does not guarantee that the provider will be accepted into the network. It may take up to 90 days for the provider to be accepted into the network. Providers must meet all established credentialing requirements. Providers must agree to all contract provisions, policies and procedures.
Mental Health Virtual Visits
• Mental health Virtual Visits are conducted online via video conference through Doctor on Demand® or MDLIVE®
• Benefits apply based on the mental health in-office visit benefit
• Appointments must be made in advance
• Psychiatrists are able to prescribe medication, if appropriate
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Mental health Virtual Visits offer a convenient option for accessing mental health care. With mental health Virtual Visits, you can consult with a licensed mental health professional any day of the week online. Normally, you would pay what you would for an in-network mental health office visit. Currently, because of COVID-19, your mental health virtual visit is fully covered—you pay nothing. Under normal circumstances, HealthSelect of Texas and HealthSelect Out-of-State participants pay a $25 copay. The rest of your Virtual Visit is 100% covered by your plan. HealthSelect Secondary participants pay 30% coinsurance after meeting the annual deductible. Consumer Directed HealthSelect participants pay 20% coinsurance after meeting the annual deductible. Again, due to the impact of COVID-19 (coronavirus), all HealthSelect participants (including Consumer Directed HealthSelect participants) can consult a Virtual Visit doctor at no cost through August 31, 2020. Mental health Virtual Visit appointments are by video conference only through either Doctor on Demand® or MDLIVE®, and you must make appointments in advance. Appointments are typically available within five to seven days but could take up to two weeks. You can choose a 25-minute or 50-minute appointment. Only psychiatrists can prescribe medication, and they will not prescribe controlled substances. Your mental health provider may also be able to provide services via a different telehealth platform. You should contact your provider’s office to ask if this service is available. These visits will be covered at the same benefit level as an in-office visit.
A BCBSTX Personal Health Assistant can:• Help you find a primary care provider
(PCP) or other in-network providers
• Assist you in the use of self-service tools, including Provider Finder
• Help connect you to other useful resources
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If you have any questions about your mental health benefits or need help finding a provider, a BCBSTX Personal Health Assistant is a great resource. Personal Health Assistants are trained to help you and your covered family members make the best use of your mental and medical health insurance benefits by:� helping you better understand your plan’s benefits and coverage, giving you cost estimates for health care services or procedures before going to the doctor or hospital, helping with referrals and prior authorizations, scheduling appointments for doctor’s visits, sharing information about useful web and mobile tools, and how to use them and connecting you with a nurse to help learn more about a diagnosis or medical condition and identify resources available to you in your community.
Thank you
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Now, we’d like to give you some time to ask us any questions you have about these updates to your HealthSelect mental health benefits.
Disclosures
Until the contract ends, Blue Cross and Blue Shield of Texas will continue to contract with Magellan Behavioral Health, Inc. (“Magellan”), an independent company administering BCBSTX managed mental health program.
In the event of an emergency, this service should not take the place of an emergency room or urgent care center. MDLIVE and Doctor On Demand doctors do not take the place of your primary care doctor. Internet/ Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only). Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation. Service availability depends on location at the time of consultation. Medical Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. The telemedicine services made available through Doctor On Demand are provided by licensed physicians practicing within a group of independently owned professional practices collectively known as “Doctor On Demand Professionals.” These professional practices provide services via the Doctor On Demand telehealth platform. Doctor On Demand, Inc. does not itself provide any physician, mental health or other healthcare provider services.
MDLIVE and Doctor On Demand operate subject to state regulations and may not be available in certain states. MDLIVE and Doctor On Demand are not insurance products nor prescription fulfillment warehouses. MDLIVE and Doctor On Demand do not guarantee that a prescription will be written. MDLIVE and Doctor On Demand do not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. MDLIVE and Doctor On Demand physicians reserve the right to deny care for potential misuse of services.
MDLIVE is a separate company that operates and administers the Virtual Visits program for Blue Cross and Blue Shield of Texas. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE® and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without written permission.
Doctor On Demand is an independent company that operates and administers the Virtual Visit program for Blue Cross and Blue Shield of Texas. Doctor On Demand is solely responsible for its operations and for those of its contracted providers.
Internet/ Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only). Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation. Service availability depends on location at the time of consultation. Medical Virtual Visits are subject to the terms and conditions of your benefit plan, including benefits, limitations, and exclusions. The telemedicine services made available through Doctor On Demand are provided by licensed physicians practicing within a group of independently owned professional practices collectively known as “Doctor On Demand Professionals.” These professional practices provide services via the Doctor On Demand telehealth platform. Doctor On Demand, Inc. does not itself provide any physician, mental health or other healthcare provider services.
Blue Cross and Blue Shield of Texas is the third-party administrator for HealthSelect of Texas® and Consumer Directed HealthSelectSM.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
