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ValueOptions FAQ: Frequently Asked Questions about using your mental health benefit
Using your mental health benefit
Finding a clinician
Filing claims
About ValueOptions
What is my mental health benefit?
In January 2004, MIT Health Plans began a partnership with ValueOptions to provide comprehensive, outpatient mental health services to its members. ValueOptions administers the mental health benefit for all MIT Health Plan members and processes all mental health claims, whether the member sees a ValueOptions or non-ValueOptions provider.
Members of the Traditional or Flexible MIT Health Plans have a mental health benefit that pays a portion of the cost of up to 50 outpatient visits per calendar year. These 50 visits include any combination of visits with both ValueOptions and non-ValueOptions providers and any psychopharmacology visits.
When a member sees a ValueOptions preferred provider for all or part of his or her 50 yearly visits (See Who is a ValueOptions in-network provider for MIT?), the MIT Health Plans will pay 75 percent of the provider's negotiated fee.
If a member sees a non-ValueOptions provider for all or part of his or her 50 yearly visits, the MIT Health Plans will pay up to 50 percent of the HIAA (Health Insurance Association of America) reasonable and customary fee schedule per type of visit (up to a maximum of $60 per visit for calendar year 2004 for all clinician licensure levels), and the member will pay the remainder, up to the total fee charged. For example, if the HIAA "reasonable and customary" fee for a particular clinician's licensure level is $70 for the type of visit billed, the MIT Health Plans will pay $35 toward the cost of a visit, and the patient will pay the balance of the clinician's actual fee (which may be higher than the HIAA "reasonable and customary fee").
What will my typical out-of-pocket costs be?
Out-of-pocket patient costs for patients who chose to see a ValueOptions provider will generally be between $15 and $25 per visit for individual therapy. For members who elect to see a non-ValueOptions provider, costs will vary according to what the provider charges. For more information about the reimbursement process, see Filing Claims.
How do I access my mental health benefit?
The first thing you need to do is find a clinician who can best meet your needs. See Finding a Clinician for more information about how ValueOptions and MIT Medical can help you in that process.
After you have identified a clinician, you need to register with ValueOptions by calling 1-866-259-7190. The identification number on the Blue Cross Blue Shield card you received when you joined the MIT Health Plan is also your ValueOptions identification number. The ValueOptions customer service representative will ask you for this number when you call to register.
What if my doctor recommends neuropsychological testing?
ValueOptions administers the neuropsychological testing benefit for members of the MIT Traditional and Flexible Health Plans. Members are covered for 50 percent of the cost of authorized services, up to a maximum reimbursement of $750 per calendar year. You must receive authorization for these services from ValueOptions before the testing takes place. Neuropsychological testing visits do not count as part of the 50 outpatient mental health visits covered under the plan.
The physician recommending neuropsychological testing will give you the name and phone number of a provider and send your records to that clinician. Contact the provider to whom you were referred and tell him or her that you are a ValueOptions member and that preauthorization is required before the neuropsychological testing can take place. You will need to provide the clinician with your insurance information and instruct him or her to call ValueOptions at 1-866-259-7190 to begin the preauthorization process. ValueOptions staff will send the clinician a form to complete and return to ValueOptions. After reviewing the information, ValueOptions will notify both the patient and the clinician in writing of their authorization decision.
Finding a clinician
Who is a ValueOptions in-network provider for MIT?
ValueOptions has many different provider networks. Providers available to MIT Health Plan members as in-network providers are those who participate in the ValueOptions "commercial network." When you call to make an initial appointment with a new provider, you should verify that the provider participates in this network.
How do I find a mental health clinician?
There are two ways to locate a mental health provider. One way is to obtain a referral through MIT Medical's Mental Health Service (617-253-2916). Alternatively, you can call ValueOptions Member Services at (1-866-259-7190).
Remember, you must register with ValueOptions after selecting a provider.
What should I do if I feel I need to speak with someone right away?
All ValueOptions clinicians provide instructions about how patients may contact them in urgent situations. If you don't yet have a regular ValueOptions provider but feel you need to speak with someone immediately, you may contact MIT Medical's Mental Health Service by phone (617-253-2916) or by stopping in during the Service's regular walk-in hours (2-4 p.m., Monday through Friday). All psychiatric emergencies are best handled at your local hospital emergency room.
I am a new member of the MIT Health Plan and am already seeing an outside clinician. How can I find out if my current clinician participates in the ValueOptions preferred provider network?
Call ValueOptions at 1-866-259-7190 and ask if your provider is a member of the ValueOptions "commercial network." You can also register with ValueOptions at this time.
What should I do if I feel the provider I've chosen isn't right for me?
If you think the provider you have chosen is not right for you, you may call the MIT Medical Mental Health Service for a consultation (617-253-2916) or contact ValueOptions (1-866-259-7190) for names of other providers that may meet your needs.
Note that once you have chosen a new provider, you will need to register again with ValueOptions.
If I am seeing a ValueOptions therapist, where should I go for a psychopharmacology evaluation and follow-up?
Visits to psychopharmacologists are included as part of the 50 clinician visits allowed under your mental health benefit. You can contact ValueOptions (1-866-259-7190) for names of psychopharmacologists who participate in the ValueOptions "commercial network." When you've made an appointment with a psychopharmacologist, you need to call ValueOptions and register again, so reimbursement will be authorized.
Be sure to inform your MIT Medical primary care physician when you begin taking any new medications.
Can I fill prescriptions from my ValueOptions clinician at the MIT Pharmacy?
Yes, you should bring all prescriptions from your ValueOptions clinician to the MIT Pharmacy. If the prescription is for a drug on the MIT Pharmacy formulary, the MIT Pharmacy will fill it immediately.
If the prescription is for a non-formulary drug, you have several options:
- You may request that the MIT Pharmacy submit your non-formulary prescription to Inman Pharmacy to be filled. In most cases, the prescription will be available for pick-up at the MIT Pharmacy within 24 hours.
- You may go to Inman Pharmacy (1414 Cambridge Street; 617-876-3979) and fill non-formulary prescription directly. Health Plan members will pay only applicable co-payments at Inman Pharmacy and do not require submission of a claims form.
- You may ask the MIT pharmacist to give you a "non-formulary slip" that will speed reimbursement of your claim. You can then fill the prescription at any pharmacy, complete a claim form (available at http://web.mit.edu/medical/pdf/claim.pdf), attach your receipt and non-formulary slip, and mail it to Claims and Member Services at MIT Medical for reimbursement.
Note: The option to use Inman Pharmacy for prescriptions is limited to prescriptions for non-formulary drugs.
Filing claims
How do I go about getting reimbursement for my mental health visits if I'm seeing an in-network provider?
ValueOptions providers will submit claims directly to ValueOptions for reimbursement. Your ValueOptions provider will either ask that you pay the 25 percent co-insurance at your visit or bill you for the co-insurance after the visit.
How do I go about getting reimbursement for mental health visits with an out-of-network provider?
If you are seeing an out-of-network provider, all reimbursement claims require the filing of a CMS 1500 form or ValueOptions claim form, both of which are available for download on the ValueOptions website. If you have any questions about completing this form please call Claims and Member Services at
617-253-5979.
There are three possible ways such claims may be filed:
- Your clinician may file the CMS 1500 claim form or ValueOptions claim form with ValueOptions and receive payment directly from ValueOptions, billing you for the balance.
- You may pay your clinician in full, and then fill out the CMS 1500 claim form or ValueOptions claim form, copying information from the clinician's bill to relevant fields of the form. Have your clinician sign the completed form, and then send it to ValueOptions, P.O. Box 1740, Latham, NY 12110.
- If you are unable to obtain your clinician's signature on the CMS 1500 claim form or ValueOptions claim form, you may fill out the form as above, and submit it, with the clinician's bill attached, to ValueOptions, P.O. Box 1740, Latham, NY 12110.
If using this option, please note that:
- The bill must be on the clinician's letterhead and must include the clinician's name, licensure level, address, tax identification number, and telephone number.
- The bill must have the patient's full name and BC/BS identification number, the individual date(s) of service listed separately, ICD-9 diagnosis code(s), CPT procedure code(s) identifying the type of visit for each date of service, and amount charged per each date of service per CPT procedure code.
- The bill must be signed by the clinician and should indicate clearly that it has been paid in full.
What should I do if I have a question about a claim?
Call ValueOptions (1-866-259-7190). A customer service representative should be able to answer your questions.
About ValueOptions
What is ValueOptions?
ValueOptions is a well-established behavioral healthcare company that provides mental health, substance abuse, and employee-assistance services to more than 23 million Americans, serving nearly 900 private-sector companies and organizations, 32 public-sector programs, and TRICARE, the Department of Defense health care initiative for spouses and families of military personnel. Since January 2004, ValueOptions has administered the mental health benefit for all MIT Health Plan members and processes all mental health claims, whether the health plan member sees a ValueOptions or non-ValueOptions provider.
In addition to providing MIT Health Plan members with a large network of mental health providers in the community, ValueOptions offers specialized inpatient and outpatient clinical programs, including treatment for eating disorders and alcohol and substance abuse.
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