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

Produced by Mental Health Legal Advisors Committee
Reviewed June 24, 2009

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


MassHealth HMO Plans

MassHealth Primary Care Clinician (PCC) Plans

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.

Fee-for-service MassHealth Plan

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

Next: How can I make sure I get the services I want?

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