Insurance complexities

Overview

The below article contains answers to the most common questions about insurance plan complexities and specific mental health carve-outs. “Carve-out” is a term that refers to specific plan services which are separated out and administered under a different network, in Rula’s case, for behavioral and mental health services. This article also reviews Medicare / Medicaid plan information.

 

Insurance Carve Outs

It’s possible your medical insurance carrier has a carve-out/different administrator for your mental health benefits! This means that your therapy visits would be billed to a different payer than what appears on your medical insurance card. If Rula is not in network with the insurer that your mental health benefits are administered through, you may receive an out of network benefits email. You can opt to be self-pay if we are out of network with your plan! Please review this article to learn more about Out-of-pocket costs without insurance.

Determining if your plan has a carve out

Insurance does not make this information easy to find! Your insurance company will always be the best source of information. You can reach your insurance company at the customer support number on the back of your ID card. When calling, you can inquire, “Does my plan have a carve-out for mental health services?” and if so, “Who administers the mental health benefits on my plan?”.

Another source of information is by Googling the mental health benefits phone number, sometimes located on the back of your insurance ID card. The result may bring up a different administrator than your medical coverage, indicating there is a carve-out. 

Magellan Carve Out 

This carve-out is common if you have Blue Shield of California as your medical insurance provider. Rula does not currently have a contract with Magellan, so an out-of-network benefits email would be received in this case. 

Halcyon Carve Out

This carve-out is common if you have Blue Shield of California as your medical insurance provider. Rula does not currently have a contract with Halcyon, so an out-of-network benefits email would be received in this case. 

Healthworks Carve Out

This carve-out is common if you have Blue Shield of California as your medical insurance provider. Rula does not currently have a contract with Healthworks, so an out-of-network benefits email would be received in this case. 

Medicare / Medicaid Plans

Today, there are many different Medicare and Medicaid plan types! Rula is not currently accepting Medicare or Medicaid plans. Some plans are “Medicare Advantage Plans”, meaning the patient has an insurance card for Medicare coverage through another administrator outside of traditional (aka original or straight) Medicare but Medicare guidelines would still apply.

Examples of Medicare Advantage plans include Aetna Medicare Advantage, Anthem Medicare Advantage, Kaiser Medicare Advantage, United Healthcare Medicare Advantage.  

Examples of Medicaid plans include Amerigroup, HealthNet MediCal, State Medicaid

Dual Eligible Beneficiaries are enrolled in both Medicare as primary and Medicaid as secondary coverage.




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