Napa's Health Insurance Guys: All About Blue Shield In Napa
My husband is enrolled in Medicare with the Blue Shield supplement. He is very ill and requires monthly medical and personal supplies. I wanted to see if these provisions were included in the plan.
When I called Blue Shield they told me we had to switch from their supplement to the Advantage plan. I didn't want to tell him anything until I called. Which give?
Kyle: One of the big differences between a supplement plan and a benefit plan is that with a supplement, the bill goes to Medicare first, then the insurance company. With the Advantage plan, the account remains “existing”. In addition to the drug plan, many benefit plans include “extras” such as dental, vision, hearing, etc.
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Tom: Many benefit plans include deductibles, co-pays, deductibles, and maximum amounts payable. They also have limited supply networks and geographic areas.
AL: Benefit plans may be issued annually by a specific region. SCAN is an employee benefits plan that was formerly available in the Napa-Sonoma area, but will launch later this year. We have enrolled a number of former SCAN members on payment and demand plans.
Kyle: We've all seen the frenzied advertising campaign promoting Advantage plans: "Just enter your zip code and see if you can get all your Medicare Part C benefits!" (A licensed insurance agent will answer your questions!)
Al: I think our reader called the sales office instead of the Blue Shield member number. At the very least, I hope they don't take over and subject our customers to a plan they don't understand.
To answer Betty's question, if Medicare covers her husband's medical supplies, the Blue Shield plan should cover them as well.
Kyle: Speaking of Blue Shield, we just learned that the company will be terminating its contract with Adventist Health effective December 1, 2023. This does not affect Blue Shield Medicare Supplements, but it can certainly affect individual plans /family (IVP) and groups. Insurance plans.
We were told that doctors affiliated with Adventist Health would be under contract with Blue Shield until next April. For people under 65, Blue Shield has become a popular choice because it is the only preferred provider organization (PPO). All other organizations are health maintenance organizations (HMOs) or specialty provider organizations (EPOs). Anthem offers Blue Cross EPO, Kaiser, Western Health Advantage, and HMO.
AL: When I started working in health insurance, Blue Shield did not have a contract with St. Louis. HELENA HOSPITAL NO. It would be surprising if the two organizations did not achieve a meeting of ideas when they need to agree. In the meantime, open enrollment continues through Covered California, so we'll reach out to our existing Blue Shield customer list so we don't have to!
How Health Insurance Coverage Affects Children's Access to Mental Health Services
How Health Insurance Coverage Affects Children's Access to Mental Health Services
According to a 2019 report by University of Michigan researchers, 1 in 6 children ages 6 to 17 in need of mental health services report at least one mental health disorder. This was before the Covid-19 pandemic, which has seriously affected children's mental health. High school students sometimes display persistent feelings of sadness or hopelessness. According to the Centers for Disease Control and Prevention's Youth Risk Behavior Survey, 42% of high school students experience these feelings in 2021, an increase of five percentage points from 2019 and 14 points from 2011. .
Yet half of young people who need professional mental health services don't receive them, according to Michigan researchers. Barriers to children's access to mental health services include: Health insurance coverage.
CounselingSchools.com examined how insurance fails to guarantee mental health coverage and the differences between Medicaid-covered youth plans and private plans, including data from the Kaiser Family Foundation.
Despite laws requiring equal mental and physical health coverage, parents may struggle to get the help their children need that is covered by insurance. Historically, health insurance companies have offered few mental health benefits. In 1996, a federal law introduced the idea of covering mental health at the same rate as physical health services, but not for all health plans. This concept was expanded by the Mental Health Equity and Substance Abuse Equity Act of 2008, which required insurers to treat mental and physical health coverage equally.
However, NPR reports that insurance companies have been lax in providing equal coverage for mental health care, often treating mental illness as an acute illness rather than a chronic illness requiring long-term care.
The rules apply to most health plans, but there are exceptions, according to the Kaiser Family Foundation. NPR cites the example of an Ohio family who had to pay $40,000 out of pocket for their son's long-term suicide treatment after his insurance company dropped coverage. Ultimately, the family faces the problem of continuing treatment and recovering expenses.
Schools are working to provide support because untreated mental health issues can affect students' learning and development. Substance Abuse and Mental Health Services Administration. In 2019, 15% of adolescents received mental health services at school. But this is not enough to meet demand.
How does children's mental health coverage in Medicaid differ from private insurance?
Under this benefit, youth may receive services for mental health, behavioral health, and developmental issues, as well as physical health screenings, as well as any other services needed to treat any mental or behavioral diagnosis, even if the program indicates that Medicaid does not cover the services. . According to the Commonwealth Fund, this benefit allows youth on Medicaid to receive higher quality and more comprehensive mental health services than youth covered by commercial insurance.
Many states use Medicaid programs to provide school-based services to children: 21 states have laws that expand Medicaid to include school-based health care, including mental health services. For example, youth covered by Medicaid in Colorado can access mental health services without a formal screening, allowing for earlier intervention, Education Week reports.
Story editing by Jeff Inglis and Kelly Glass. Copy editing by Tim Bruns.
This story originally appeared on CounselingSchools.com and was produced and distributed in partnership with Stacker Studios.
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