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Gaps In Service; Insurance & Managed Care

 
       projectfreshlight.org Forum Index -> Critical Service Gaps Involving Insurance
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pfladmin
Site Admin


Joined: 11 Apr 2007
Posts: 5
Location: Madison WI

Posted: Wed Sep 12, 2007 8:19 pm    Post subject: Gaps In Service; Insurance & Managed Care

As we explore the gaps in service for youth, in either AODA or mental health issues, we are hearing many stories of successful collaboration with insurance and managed care. We are also aware of significant unintended consequences between consumers. providers and insurance/managed care.

Please send us your stories! We need to compile a set of narrative data to develop strategies regarding the financial and reimbursement issues that have been addressed by Project Fresh Light.

Your efforts will help us best if we get your stories by the end of October.

We ask that you not include in your public post any specific names of people, insurance plans, agencies, HMOs, etc. We will contact you for those peculiars as needed.

Thank you, in advance, for your time and effort. Please contact Mary, Susan or myself if you have any questions.


Michael
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Bill



Joined: 01 Aug 2007
Posts: 2
Location: Madison, WI

Posted: Wed Sep 12, 2007 10:26 pm    Post subject:

1) As a Day Treatment provider, we are a level of service that insurances lump under transitional services. This generally has resulted in approval for 9 days of service. One company kindly saw that we meet for one half day so they granted twice the usual number of days. Still, 20 days of day treatment just gets you started.
2) I am hearing from EDS that MA payments are based on medical necessity, but hearing from other providers that no one gets more than 6 weeks for Day Treatment. Bill
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Bill
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