Memo to Allegheny Approved Mental Health Providers from the Authorization Unit

At Allegheny Health On Tap, the health of our subscribers is our only business. If they are not well served, truly our lives are not worth living.

In keeping with this mission, Allegheny offers three different mental health plans. Since many of you mental health providers seem to have a problem understanding this, let us go over it one more time.

The Allegheny Free Spirit Plan pays for 80% of the accepted standard cost of 26 mental health visits per year, no questions asked. The Free Spirit Plan is so supportive of our subscribers’ emotional health that it was recently cited by the State Association of Health Insurance Providers as Best Mental Health Insurance Program of the Millennium. While no employer has yet decided to buy this plan, it is in all our brochures and it is still available for only $25,000 per subscriber per year.

The Allegheny Standard Plan pays for 60% of the accepted standard cost of 10 mental health visits per year, with a $50 co-pay and a $1,000 deductible. Halfway into the first visit, providers must use our live computer connection, Allegheny On The Wire, to provide the Authorization Unit with a diagnosis of the subscriber’s mental condition which is on our Approved List of Mental Conditions. If you do not provide a diagnosis at this point, we will not pay for this visit or for any subsequent visits, regardless of the volume of paperwork you submit or the number of phone calls you place to our office, none of which we can accept.

If your diagnosis is depression, and you choose to go ahead with the balance of the 10 visits, you will be required to state within 24 hours why you are not prescribing drugs instead of more visits. Frequently, drugs work in alleviating depression without the expensive intrusion of a therapist. Skeptical providers can confirm this by checking both WebMD and Readers Digest. We urge you to prescribe drugs for all subscribers, particularly those who have purchased the new Allegheny Pill Popper’s Card, entitling them to half off on all generics when purchased by the case.

Finally, the Allegheny Budget Plan offers no mental health visits or any other doctor visits under any conditions. But it does offer a 10% discount on drugs, which is a damn good deal and these people who get it should be grateful for it and shut up.

The problem we are having with many of you therapists is in providing care under the Allegheny Standard Plan. The first difficulty stems from a pathological refusal on your part to understand the meaning of the $1,000 deductible. The concept of a deductible should be part of your mental health training, but apparently it isn’t. Perhaps an example will illustrate. If your patient has a psychotic episode which requires $1,000 worth of care, she will have to pay for it out of her own pocket. However. If she has a second crack-up of equal magnitude, her treatment will be totally free! We find that when you take the time to actually explain this to patients, they can’t believe their good fortune.

Second. Your diagnosis must be on the Allegheny List of Approved Mental Health Conditions. If your patient has some condition which is not on the List of Approved Mental Health Conditions, then they do not have a mental health condition. We simply cannot be more clear about this.

In many instances, we are finding that providers who are not happy with the List have been filling in diagnoses that are not on the List. These include such findings as “Marriage fatigue,” “Stress fatigue,” and “General fatigue.” If you continue to submit applications with these types of diagnoses, not only will they not get processing numbers, but all other applications with the same provider number, i.e. your payments, your livelihood, your money, your filthy lucre, will be held up indefinitely.

All the best to you and your families including, but not limited to, the coming St. Patrick’s Day holiday.