employee assistance program (eap) & behavioral health benefits private line november 13, 2008...
TRANSCRIPT
Employee Assistance Program (EAP) & Behavioral Health
Benefits
Private Line
November 13, 2008
Nina Martinez, Senior Account Manager
Lee Tulumello, RN, Manager Clinical Operations
Michael Denson, LCSW, Supervisor Clinical Operations
Diana Cervantes, Account Representative
2
Who We Are
MHN is a leading healthcare company, providing behavioral health, EAP, and wellness and productivity solutions for individuals and organizations. We help employees live better so companies work better.Capable
» Wholly-owned subsidiary of Health Net» URAC accredited
Experienced» 30+ years of providing behavioral solutions that improve productivity and
health» Clients include national/international Fortune 500 companies, government
agencies, health plans and unions» Working with PBG for over 15 years
Proven» 860 clients, representing nearly 10.5 million members
Accessible» Headquartered in San Rafael, CA» Nationwide network of more than 44,000 providers and 1,400 care
facilities
3
EAP and Behavioral Health
Call 1(800) 646-5608
24 hours a day, seven days a week
Confidential
Visit www.members.mhn.com
Access code: pbg
4
Provider Network
» It is MHN's policy to develop and maintain an adequate network in number and type of individual practitioners to ensure access to all needed specialties. The network is considered adequate if all of the following criteria are met:
• There is one psychiatrist per 5,000 covered lives• There is one psychologist per 5,000 covered lives• There is one master's level clinician per 2,300 covered lives• All members have at least one practitioner of each type within
a 30 mile radius, facility within 60 mile radius
» The adequacy of the network is assessed on an annual basis» Providers and facilities recredentialed: Every three years» All providers must notify MHN if full practice, vacation, personal
leave » MHN provider Geographic Access Reports for each clinic» Provider Network Referrals? Contact Acct Mgr – Nina Martinez
5
MHN Protocol
Care Manager performs full assessment to determine if member requires routine, urgent, emergency life-threatening or non life-threatening appointment
» Routine: appointment within 10 business days
» Urgent: member likely to pose imminent danger to self or others or become gravely disabled; appointment within 48 hours
» Emergency non life-threatening: appointment within six hours
» Emergency life-threatening: member in imminent danger of harming self or others and is gravely disabled; member requires immediate help
6
EAP vs. Behavioral Health Eligibility
» EAP: Available to all employees and their dependents regardless of PBG medical plan election
» Behavioral Health: Available to all employees and their dependents enrolled in a PBG PPO medical plan
7
EAP vs. Behavioral Health
Behavioral health summary plan descriptions can be found online at the PBG & You Benefits book - www.pbg.spdsonline.com
EAP Behavioral Health
Assessment and referralBased on medical necessity
Short term Diagnosis involved
Problem focused Co-payment may apply
No co-payment Psychiatric care
3 Face to Face sessions per incident per calendar year
Inpatient treatment
Unlimited telephonic sessions
Longer term therapy
8
EAP Contacts
MHN clinical contact in Irving, TX:
Brenda Maxey, Senior Care Manager: (972) 550-2544
MHN Account Management – Huntington Beach, CA:
Nina Martinez, Account Manager: (714) 934-5572