MEDICAL PLAN COVERAGE – OLDER ADULTS.docVIP

OVERVIEW: BEHAVIORAL HEALTH INSURANCE COVERAGE FOR OLDER ADULTS Updated March 2012 by LIFE Senior Services for Tulsa Aging and Behavioral Health Multidisciplinary Team Older adults face many challenges in accessing behavioral health services due to the rules of insurance plan coverage. Depending on the health plan, challenges may involve deductibles, coinsurance, and co-payments, in network and out of network coverage. It follows that it is very important to know the insurance plan coverage before making a referral. Unfortunately, most current behavioral health providers do not provide home-based services, yet, clearly most people prefer to receive services in their homes. - T he information provided below reviews insurance plan coverage issues that should apply to 80-90% of the people you may serve. - The overview references “Outpatient” and “Inpatient” services separately as different eligibility rules apply for in-network versus out-of-network services. OUTPATIENT No Insurance Community Mental Health Centers (CMHCs) accept people with chronic mental illness on a sliding scale. The Mental Health Association of Tulsa (MHAT) recruits volunteer providers who can manage non-complicated cases (Bright Sky Program) at $5.00 session. The Alzheimer’s Association of Oklahoma Arkansas provides some grant-funded services to older adults, caregivers and grandparents caring for grandchildren. Medicare (only) Qualified Providers are able to serve persons with regular Medicare in their outpatient clinics: Physicians Psychiatrists Licensed Psychologists and Social Workers in the Community (may not be included in the attached Environmental Scan). Most facility-based outpatient providers are able to provide Medicare outpatient services, i.e.: Brookhaven Hospital Laureate Hospital Parkside Hospital University of Oklahoma St. John Behavioral Health Services CMHCs will provide Medication Management via a physician for individuals who have regular Medicare, but generally