Who decides whether my mental health care services are paid for?

Sometimes your insurer decides and sometimes a private company with whom the insurer contracts.

MassHealth:

The Medicaid HMOs are Fallon Community Health Plan, Network Health Plan, Boston Medical Center HealthNet Plan, and Neighborhood Health Plan. Boston Mental Center HealthNet and Network Health oversee their members’ mental health services themselves. Fallon and Neighborhood Health plan use Beacon Health Strategies, a separate private company, to manage their members’ mental health services.

With the PCC program, you choose a primary care clinician (usually a doctor), who oversees your physical health care. A separate private company, the Massachusetts Behavioral Health Partnership (“MBHP”) manages your mental health care services.

If you have fee-for-service MassHealth, your mental health services are not managed by a private insurer or “carveout” company. MassHealth pays for your services but often covers fewer services than those provided to persons in its HMO or PCC plans.

Private Insurance:

Private insurers, like Harvard Pilgrim Health Care (HPHC) may use separate private companies to manage their members’ mental health care services. HPHC currently uses PacifiCare. Other insurers, like Tufts, manage mental health care services for most of their members but not for others, depending on whether the employer wants to use a private company like United Behavioral Health to manage their employees’ mental health care benefits.

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