Magellan Behavioral Health Insurance

07/11/Revdex.com Serving Eastern Missouri and Southern IllinoisAttention: Dispute Resolution Department [redacted] NBroadway, Ste 2060Saint Louis, MO Re: Case Number: [redacted] Member: [redacted] *** Provider: Dr [redacted] A [redacted] Dear Dispute Resolution Department: This letter serves as a response of Magellan Healthcare, Inc(Magellan) to your letter dated June 24, in connection with the above-referenced complaint filed with your office Magellan contracts directly with [redacted] ***, headquartered in Columbus, Ohio, to manage its behavioral health benefits under its self-funded employee welfare benefit plans and its Employee Assistance Program (EAP) There is no insurance company or HMO involved in the administration of mental health benefits under the [redacted] plan or its EAP Thus, federal law preempts any state law remedies that a covered plan member may seek to assert against the plan and its claims administrator(s)Further, federal privacy law prohibits Magellan from communicating “protected health information” about a plan member to you absent a HIPAA-compliant authorization executed by such member Thus, Magellan cannot now communicate to you anything substantive about the member’s complaint, because the member’s complaint involves “protected health information” under HIPAA However, please note that Magellan reviewed the member’s claim and appropriate actions (processed claim minus member’s deductible) have been taken If I can provide any additional information not implicating federal privacy law, please do not hesitate to contact me Sincerely, [redacted] , RN, MSL, CCMManager, AppealsMagellan Healthcare

Tel Respond to Complaint Revdex.com Serving Eastern Missouri & Southern Illinois [redacted] *** StLouis, MO ph [redacted] http://www.Revdex.com.org/stlouis 11/20/This is an acknowledgement of the receipt of # [redacted] complaint Magellan Health Service will review the complaint and provide a response on or before December 19th[redacted] Manager of Appeal/Complaints l us why here

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and I await the response from magellanPlease inform magellan that ALL of the claims electronically filed by the provider have been rejectedThe response by the regional supervisor mr *** *** is unacceptable to me
Sincerely,
*** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** *** ***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.
Sincerely,
[redacted]

This email is to acknowledge receipt of this complaint.  Magellan will conduct an investigation into the issues noted. [redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and accept further investigation on the part of Magellan Behavioral Health.
Sincerely,
[redacted]

Tel Respond to Complaint   Revdex.com Serving Eastern Missouri & Southern Illinois [redacted]  St. Louis, MO 63102 ph [redacted]  http://www.Revdex.com.org/stlouis 11/20/2017 This is an acknowledgement of the receipt of #[redacted]...

complaint.  Magellan Health Service will review the complaint and provide a response on or before December 19th.[redacted]Manager of Appeal/Complaints  l us why here...

This complaint was specific to Magellan Healthcare’s failure to pay therapist claims on behalf of a member we serve through Kaiser Health Plan.  Unfortunately, Magellan did, in fact, struggle to timely pay this member’s therapist and our team is very sorry for any inconvenience this has caused...

the member.  At the time of this member’s referral, Kaiser did not send Magellan an eligibility file of members.  As a result, the process of entering the required information to pay a claim was entered manually.  During this process, the spelling of the member’s name was entered incorrectly (the last letter of the first name was missing), which prevented the alignment of the necessary pieces required to pay the claims.  During subsequent phone calls with our Customer Service Agents, that spelling that was already in our system, continued to prevent the final processing of the claims.  Once this was escalated to the Department Manager, the situation was rectified and all past claims dating from 9/16/2016 have now been paid and the ongoing claims process has resulted in timely payments for her last two visits, as well.  We do not anticipate further issues for this member.  As a side note, we have been working with Kaiser since the program’s inception to provide us with a routine electronic eligibility file.  That process is almost complete and we expect that to go live on March 6th.  At that point forward, the issue affecting this member, can no longer occur for her or any other member seeking therapy services.ell us why here...

07/11/2017 Revdex.com Serving Eastern Missouri and Southern IllinoisAttention:  Dispute Resolution Department [redacted]211 N. Broadway, Ste 2060Saint Louis, MO 63102 Re:   Case Number: [redacted]       ...

Member:            [redacted]        Provider:            Dr. [redacted] A. [redacted]                                   ...⇄                                         ...⇄ Dear Dispute Resolution Department: This letter serves as a response of Magellan Healthcare, Inc. (Magellan) to your letter dated June 24, 2017 in connection with the above-referenced complaint filed with your office.  Magellan contracts directly with [redacted], headquartered in Columbus, Ohio, to manage its behavioral health benefits under its self-funded employee welfare benefit plans and its Employee Assistance Program (EAP).  There is no insurance company or HMO involved in the administration of mental health benefits under the [redacted] plan or its EAP.  Thus, federal law preempts any state law remedies that a covered plan member may seek to assert against the plan and its claims administrator(s). Further, federal privacy law prohibits Magellan from communicating “protected health information” about a plan member to you absent a HIPAA-compliant authorization executed by such member.  Thus, Magellan cannot now communicate to you anything substantive about the member’s complaint, because the member’s complaint involves “protected health information” under HIPAA.  However, please note that Magellan reviewed the member’s claim and appropriate actions (processed claim minus member’s deductible) have been taken.  If I can provide any additional information not implicating federal privacy law, please do not hesitate to contact me.  Sincerely, [redacted], RN, MSL, CCMManager, AppealsMagellan Healthcare