Below is a summary of responsibilities if you are referred for treatment beyond the services rendered through the EAP/MAP. These procedures apply only if Mines & Associates (MINES) is responsible for managing your mental health benefits. Please review this carefully and discuss any questions you have with your therapist.
- The client will access all mental health care through MINES.
- The client will encourage the provider to comply with authorization requirements so that their services will be authorized.
- The client will know their benefits and will contact their insurance to clarify any questions and verify eligibility.
- The client will clarify with their insurance and/or MINES the network status of their provider, as reimbursement rates are dependent upon network status and provider compliance with authorization procedures.
- After having concluded an episode of care, the client will contact MINES before reinitiating services with any provider.
Responsibilities of MINES & Associates
- MINES will authorize clinically appropriate treatment at the appropriate level of care and will not verify eligibility of the insured.
- MINES will assess thoroughly the client's current circumstance and need, and if warranted, make an appropriate referral that enables the client to access their insurance benefits.
- MINES will assure that the appropriate provider is available to take on new clients and will facilitate the client's contacting the provider for an appointment.
- MINES will send an Authorization Form to the client's insurance company to inform them that the services authorized are clinically necessary. Copies of this authorization will be provided to the provider.
- Prior to the expiration of an authorization for services, the provider will submit the appropriate written treatment plan or update form outlining the goals for treatment and the planned interventions. No additional sessions will be authorized until the treatment plan or update is received and approved by MINES.
- The provider will verify insurance eligibility of the client prior to the initiation of treatment, including benefit exclusions in terms of diagnosis and/or treatment modality.
- The provider will keep the client up-to-date on their progress in treatment and their recommendations.
- The provider will contact MINES prior to making any additional referrals for any other mental health related treatment.
- If the therapist fails to comply with these procedures, MINES will not be able to authorize treatment. The provider may not pass along the costs to the client for this noncompliance. If the client elects to remain with this provider, the client will be responsible for future fees incurred.
Insurance Company Responsibilities
- The insurance company is responsible for paying for appropriately authorized services based upon the client's eligibility and according to the parameters of the client's benefit plan. Only services authorized by MINES are eligible for reimbursement based upon benefit availability and enrollment status.