Empire Plan Managed MHSA

Transition of Care Benefit FAQs 

Q1:        What is the transition of care benefit?

A:         The transition of care benefit allows you to continue to receive network benefits even if your provider has not joined the OptumHealth network as of January 1, 2009.  All levels of care are covered under the transition of care benefit.

Q2:        How do I access my transition of care benefit?

A:         You do not need to call or complete any forms to access the transition of care benefit.  If you received network benefits between July 1, 2008 and December 31, 2008, you will automatically be given the transition of care benefit through March 31, 2009, for services received from the same provider, even if that provider is not in the OptumHealth network.  Please note that these benefits apply to covered services received between January 1, 2009 through March 31, 2009.

Q3:        If I already have certification from ValueOptions and will be using the transition of care benefit, will my certification from ValueOptions transfer over, or do I need to call OptumHealth?

A:         You do not have to call OptumHealth, but you may call if you have any questions 24 hours a day, 7 days a week at 1-877-7-NYSHIP (1-877-769-7447) and press Option 3 and select the 2009 MHSA option.

Q4:        I just checked the website and my provider is not currently in the OptumHealth network.  What are my options?

A:         The transition of care benefit allows you to receive network benefits, even if the provider you were seeing in 2008 is not part of the OptumHealth network.  When the transition period ends on March 31, 2009, you must use an OptumHealth network provider to receive the highest level of benefits.  You may call us at any time to access network benefits.  If you continue treatment with your provider after March 31, 2009 and your provider is not part of the OptumHealth network, your treatment will be covered under the non-network benefit, and you will have higher out-of-pocket costs.

Q5:        How can my provider become part of the OptumHealth network?

A:         If your provider is not currently in the OptumHealth network, you may nominate your provider by calling 1-877-7-NYSHIP (1-877-769-7447) and press Option 3 and select the 2009 MHSA option, or your provider may call OptumHealth directly at the same number.

Q6:        My dependent may be receiving inpatient treatment at the end of the year and I’m worried about their care.  How will it be handled?

A:         ValueOptions will continue to monitor the care of anyone who is confined to a hospital or residential treatment facility on December 31, 2008, and remains confined on January 1, 2009.  Once discharge to another facility or another level of care occurs, all treatment will be managed by OptumHealth.

Q7:        What should I do if I need MHSA services before the end of the year?

A:         If you need treatment that will be received prior to January 1, 2009, call 1-877-7-NYSHIP
(1-877-769-7447) and press Option3 and select the 2008 MHSA option for ValueOptions.

Q8:        What if I need treatment after the beginning of the year and I am not eligible for the transition of care benefit?

A:         To find a network provider for treatment on or after January 1, 2009, call 1-877-7-NYSHIP
(1-877-769-7447) and press Option 3 and select the 2009 MHSA option for OptumHealth.

12/4/08