RAVI’S PROVIDER UPDATES
Hope you’re well and enjoying the snowy weather! This message is for therapists and providers serving Summit County clients through health insurance and Building Hope’s scholarship program.
As you may have heard, Bright Health is leaving CO and it’s a big blow to the behavioral health landscape of Summit. We’re looking forward to facing this challenge by banding together as a community in order to figure out how to best approach this and continue to provide services and support to our Summit County clients.
The current direction we’ve received from the county is that Friday Health Plans and Anthem Blue Cross are the two main plans that will be used by employers and individuals for the 2023 plan year (until Peak is able to negotiate with another carrier for 2024), followed closely by Cigna and UnitedHealthCare. We are asking that you please consider credentialing with these four plans, if you are not in-network with them already.
We will be discussing this topic specifically during our next monthly provider meeting, which will take place next week on Tues, Nov 1st at 8am on Zoom. If you’re not already on the calendar invite, please let me know and I’ll add you.
Lastly on this matter, payment issues seem to be continuing with Bright. When you’re reaching out to follow up on reimbursement concerns, please follow the Bright process in their provider portal, however please CC the Dept of Insurance on your communications with them, as that will get their attention: firstname.lastname@example.org. If you have additional questions on how to handle Bright reimbursement issues, please email John Snyder at Peak: email@example.com.
As we look towards the loss of mental health coverage provided by Bright Health, we foresee an increase of pressure on our scholarship program. We are happy to report that we recently received a large grant to cover scholarship sessions, but in order to take advantage of these new funds we will be changing our scholarship program policies and processes over the next several months.
As grant dollars become a major funding source for us, we are required to report under extremely stringent, exact criteria and timely manner:
- It will be of utmost importance that our scholarship providers submit their invoices on a timely basis, no later than the 5th of the month.
- Invoices cannot include backbilling or sessions combined over multiple months.
Our other major change will be the benefits verification process:
- If a client has health insurance, we will offer them a no-questions-asked 3 session scholarship and refer them to a provider that accepts their insurance.
- It will be the provider’s responsibility to verify their benefits within 3 sessions and inform us whether the client’s insurance is viable or not.
- If the insurance is viable, we request you to switch over to their insurance within the 3 sessions.
- If their insurance is not going to cover services, we will unlock the rest of the 12 sessions when you notify us.
- If you’re able to bill insurance immediately then please do so as to preserve scholarship funds. The 3 sessions are meant to be a “bridge” in case there are issues with insurance.
- Any issues that arise around timely reimbursement by insurance, or inability for the client to afford their copay, potentially applying scholarship funds to the client’s deductible — all these will be handled on a case by case basis.
In order to support your adolescent clients, we also request that you credential with Second Wind Fund, and with iMatter so that additional scholarship sessions can be accessed outside our program.
Lastly, we will be switching to a fully automated online platform called Mountain Strong for scholarship issuing and billing in early 2024. This platform has been developed by Eagle Valley Behavioral Health and we are very excited to finally modernize our scholarship program and automate billing, tracking, etc. If you are interested in piloting this program and getting early access, please let me know.
2024 is going to be a big year that will change the mental health landscape of Summit County. We will work with you as best we can to make these transitions smooth and easy to navigate. These changes and processes will help support our community, preserve our scholarship program and ensure that we are able to pay you on time. Please don’t hesitate to reach out so that we can work with you to ensure processes remain as sustainable and seamless as possible.
We will be updating our MOUs with the above new scholarship changes as the year comes to a close and more processes are solidified. Please don’t hesitate to reach out if you have any questions and we can set up a call to discuss further.
Hoping to see you at our next Provider Mixer on Dec 13th @ Highside Brewing in Frisco!