Is it the intention of your self-funded health plan to cover this?
Have you done anything to make sure your intentions are carried out by your administrative team?

Do you think that because of Parity & ACA that you have no choice but to take it lying down?
Have you seen the $4,000+ per night Resort-style mental health treatment facilities getting paid for by your plan?

There’s a tsunami, and if it hasn’t hit your self-funded health plan yet, it’s about to!

Parity (still) doesn’t mean that you can NOT manage utilization – no matter what providers, patients, your TPA/Carrier, or your medical management team says. YOU CAN MANAGE UTILIZATION ON MENTAL HEALTH SERVICES AND STILL BE COMPLIANT WITH THE LAW!

ACA (still) doesn’t mean that you can NOT manage mental health utilization – no matter what providers, patients, your TPA/Carrier, or your medical management team says. YOU CAN MANAGE UTILIZATION ON MENTAL HEALTH SERVICES AND STILL BE COMPLIANT WITH THE LAW!

Because patients, providers, and yes even TPAs/Carriers and medical management vendors have taken a stance that is misguided, ill-informed, our just outright deceptive and incorrect, it doesn’t mean you have to fall for it! What’s more, the number of patients seeking mental health, chemical dependence/substance abuse treatment is also on the rise. Perhaps because so many have mis-applied Parity and ACA, it seems like there has been a huge upsurge in mental health, chemical dependence/substance abuse facilities.

This is America, where there is money to be made we will open a business to capitalize on the opportunity! Your self-funded major medical health plan may be stuck holding the bag (or at least paying the bill). Don’t give up hope yet because there IS a solution to this conundrum. With the right medical management solutions you can prevent your plan from paying for facilities and/or services that you never intended to cover. You’ve just got to have the right medical management vendor as your partner.

Ready to do something about it?

AIMM can Help!

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Deborah Ault, RN, CCM, CCP, AATMC, MBA

Deborah has been a Registered Nurse for over 29 years (lovingly referred to as “Nurse Deb”). Before getting into Care Management, her bedside nursing experience included ER, ICU, Doctor’s Office, Home Health, and Telephone Triage. Now she is the President of Ault International Medical Management (aka AIMM).

Her team of Nurses and Doctors help patients make sure they are getting the right care, at the right time, in the right place, for the right reason, at the right price, with the right documentation, and generating the right outcome. This is done by ensuring that patients have all the information and tools they need to help them be as healthy & happy as possible as quickly as possible. AIMM also helps patients to navigate the insurance system.