Pathways Online Resource Directory
Health
Insurance
The following information relates to accessing primary or
supplemental health insurance through
Mass Health,
Mental
Health Parity in Massachusetts, and tips for
negotiating with private health insurance companies.
Mass Health
Mass Health
has a number of programs for which a child and/or a family
may qualify. Families who do not meet financial guidelines
for one program may meet the guidelines for another program.
Different programs within Mass Health calculate family
income and family size differently. Regardless of family
income, children and youth can become eligible for Mass
Health when their medical or mental health condition
requires more care than routine checkups offer (e.g. ADHD,
OCD, PTSD, depression, bipolar disorder, anxiety disorders,
autism, etc.). Mass Health can increase or supplement
primary insurance coverage for a family with a disabled
child. Click here to see a complete listing of
Massachusetts State Health Programs Eligibility and Coverage.
The process:
1. Complete, copy and mail basic application.
2. You should receive notification with disability
supplement within a few weeks. If not, call 1-800-843-7114;
ask for supplements, and resend application, resigned in
blue ink.
3. Complete, copy and send disability supplement. To hasten
process sign all releases. Send as many files and records
you have as possible with the disability supplement to
expedite the process.
4. Notification of receipt should arrive within two weeks.
If not, call for status on a claim 1-800-242-1340. If not
found, resend application with signatures in blue ink.
5. Disability determination can take as long as three
months. Mark your calendar and if you haven’t heard by then,
call for status and/or to offer more information
1-800-888-3420.
6. If you continue to get notices asking for the same
information again and again, call to help straighten out any
confusion 1-800-888-3420.
7. If your application is rejected, turn the form over and
fill out the formal request for a hearing. You should be
contacted within two weeks. Applications are often denied
because of lack of sufficient information.
General Links:
Mass
Health application
Mass
Health Information
Agencies that can help with obtaining Mass Health insurance:
Health
Care for All 1-800-272-4232
Manet
Community Health Center 1-857-403-0451
Important Phone Numbers:
Mass Health 1-800-841-2900
Status of your Application 1-800-242-1340
Disability Determination Unit 1-800-888-3420
Central Processing 1-800-843-7114
Benefit Coordination and Recovery 617-210-5192
Mental Health Parity
Private
insurance companies must provide the same coverage for
mental health needs as for physical health needs. In
Massachusetts, this includes coverage for the following
disorders: autism, eating disorders, post traumatic stress
disorder and substance abuse disorders in children and young
adults.
Negotiating with
Private Insurance Companies
Your primary insurance company is a business. Your task is
to show them that the services you are requesting for your
child are the most cost effective way to maintain your
child’s mental health and normal level of functioning (e.g.
therapy is less expensive than hospitalization).
Steps:
1. Start with the number on the back of your primary
insurance card. Have your child’s medical records available;
this will facilitate the conversation and increase your
chances of getting additional services.
2. The first representative with whom you speak is often
only helpful with routine problems. Ask for a case manager
or supervisor. You may have to be assertive; be prepared to
call back many times and wait on hold…be patient.
3. Ask for the names of the individuals with whom you speak.
If your child has a diagnosis he (she) may have been
assigned to a case manger; ask this person if they have the
training and authority to authorize services for your child.
4. Start a paper trail and keep notes of all phone
conversations. Address a letter to the medical director (by
name) expressing the seriousness of your child’s condition
and possible expenses of your child’s treatment.
Helpful
Websites:
Massachusetts
Department of Public Health
Harvard
Vanguard
Tufts
Health Plan
Blue
Cross Blue Shield
