Employee Assistance Program (EAP) & Behavioral Health Benefits Private Line November 13, 2008 Nina Martinez, Senior Account Manager Lee Tulumello, RN,

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Presentation transcript:

Employee Assistance Program (EAP) & Behavioral Health Benefits Private Line November 13, 2008 Nina Martinez, Senior Account Manager Lee Tulumello, RN, Manager Clinical Operations Michael Denson, LCSW, Supervisor Clinical Operations Diana Cervantes, Account Representative

2 Who We Are MHN is a leading healthcare company, providing behavioral health, EAP, and wellness and productivity solutions for individuals and organizations. We help employees live better so companies work better. Capable »Wholly-owned subsidiary of Health Net »URAC accredited Experienced »30+ years of providing behavioral solutions that improve productivity and health »Clients include national/international Fortune 500 companies, government agencies, health plans and unions »Working with PBG for over 15 years Proven »860 clients, representing nearly 10.5 million members Accessible »Headquartered in San Rafael, CA »Nationwide network of more than 44,000 providers and 1,400 care facilities

3 EAP and Behavioral Health Call 1(800) hours a day, seven days a week Confidential Visit Access code: pbg

4 Provider Network »It is MHN's policy to develop and maintain an adequate network in number and type of individual practitioners to ensure access to all needed specialties. The network is considered adequate if all of the following criteria are met: There is one psychiatrist per 5,000 covered lives There is one psychologist per 5,000 covered lives There is one master's level clinician per 2,300 covered lives All members have at least one practitioner of each type within a 30 mile radius, facility within 60 mile radius »The adequacy of the network is assessed on an annual basis »Providers and facilities recredentialed: Every three years »All providers must notify MHN if full practice, vacation, personal leave »MHN provider Geographic Access Reports for each clinic »Provider Network Referrals? Contact Acct Mgr – Nina Martinez

5 MHN Protocol Care Manager performs full assessment to determine if member requires routine, urgent, emergency life-threatening or non life- threatening appointment »Routine: appointment within 10 business days »Urgent: member likely to pose imminent danger to self or others or become gravely disabled; appointment within 48 hours »Emergency non life-threatening: appointment within six hours »Emergency life-threatening: member in imminent danger of harming self or others and is gravely disabled; member requires immediate help

6 EAP vs. Behavioral Health Eligibility »EAP: Available to all employees and their dependents regardless of PBG medical plan election »Behavioral Health: Available to all employees and their dependents enrolled in a PBG PPO medical plan

7 EAP vs. Behavioral Health Behavioral health summary plan descriptions can be found online at the PBG & You Benefits book - EAPBehavioral Health Assessment and referral Based on medical necessity Short term Diagnosis involved Problem focused Co-payment may apply No co-payment Psychiatric care 3 Face to Face sessions per incident per calendar year Inpatient treatment Unlimited telephonic sessions Longer term therapy

8 EAP Contacts MHN clinical contact in Irving, TX: Brenda Maxey, Senior Care Manager: (972) MHN Account Management – Huntington Beach, CA: Nina Martinez, Account Manager: (714)