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What is covered for testing?
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<blockquote data-quote="bigblueagain" data-source="post: 4299" data-attributes="member: 909"><p>Since I know work for a company that administers mental health benefits which are separate from the medical health benefits, I would advise to check with your mh carrier to see if they are a carve out from your medical. Then you need to see your booklet for coverage and EXCLUSIONS. We pay for NO MEDICAL tests under our plan, as lab tests, xrays etc are always considered as being done for a MEDICAL condition. This is actually mandated by the employers whose employees we cover. BLue Crosses are notorious for saying anything that comes in with a mental health diagnosis goes thru the MH carrier....even if it is a medical test. We however CANNOT cover them as it is a specific exclusion under the language of the contract. From time to time if you get your employer involved they can supercede the language but only if they are SELF INSURED....meaning it's the companys own dollars, not ours.(We are only an administrator, not an insurer, the employers are actually considered the insurer.) This however at time causes problems as most employers don't want to set a precedence of allowing one thing for one employee as they will have to allow for all. So as I always say and as the article from the link says, get the appeals process down and try to get alllll needed infor on the front end. </p><p>For my part I have never heard of a DAN physician, and from what I see that they are mandating an open account they already know their charges are non-remimbursable by insurers or administrators, and expect you to have pay for them. They probably won't even file any paperwork for you. So I can't advise you to what to do on that issue.</p><p>BLUE</p></blockquote><p></p>
[QUOTE="bigblueagain, post: 4299, member: 909"] Since I know work for a company that administers mental health benefits which are separate from the medical health benefits, I would advise to check with your mh carrier to see if they are a carve out from your medical. Then you need to see your booklet for coverage and EXCLUSIONS. We pay for NO MEDICAL tests under our plan, as lab tests, xrays etc are always considered as being done for a MEDICAL condition. This is actually mandated by the employers whose employees we cover. BLue Crosses are notorious for saying anything that comes in with a mental health diagnosis goes thru the MH carrier....even if it is a medical test. We however CANNOT cover them as it is a specific exclusion under the language of the contract. From time to time if you get your employer involved they can supercede the language but only if they are SELF INSURED....meaning it's the companys own dollars, not ours.(We are only an administrator, not an insurer, the employers are actually considered the insurer.) This however at time causes problems as most employers don't want to set a precedence of allowing one thing for one employee as they will have to allow for all. So as I always say and as the article from the link says, get the appeals process down and try to get alllll needed infor on the front end. For my part I have never heard of a DAN physician, and from what I see that they are mandating an open account they already know their charges are non-remimbursable by insurers or administrators, and expect you to have pay for them. They probably won't even file any paperwork for you. So I can't advise you to what to do on that issue. BLUE [/QUOTE]
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