Agmt23 AETNA - Laserfiche WebLink

Browse Search

HHRC-EOC 02.10.2017 8 Evidence of Coverage the termination by the California Department of Managed Health Care. For more information, contact our Customer Service Department. NOTE: If the EAP Services Agreement is terminated by Plan, reinstatement with Plan is subject to all terms and conditions of the EAP Services Agreement between Plan and the employer. XIII. CONTINUITY OF CARE A. New Members 1) Eligibility Any newly covered Member with an acute, serious, chronic, or other mental health condition who has been receiving services from a licensed mental health provider who is not on Plan’s panel is eligible for continuation of care. This does not include the services of psychiatrists, as the EAP benefit does not include psychiatric care. If you are newly covered under the EAP, you will be offered the option of continued care with your non-plan provider through the EAP. The Manager of Provider Relations or the Director of Clinical Services will review all requests for continued care with a non-plan provider. Consideration will be given to the potential clinical effect that a change of provider would have on your treatment for the condition. Notification of the referral acceptance is by telephone and a referral confirmation to the provider. If the provider declines to provide services, you will be notified in writing. 2) Access You may access the services of the provider by calling Plan and indicating to the intake person that you have an ongoing client-patient relationship with the Provider. You then should ask the Provider to call and provide information to Provider Relations to be added to the panel for you. The non-plan provider must agree to continue until one of the following occurs: a. The episode of care is completed. b. Your benefit is exhausted, in which case you will be transitioned to other ongoing care. c. A reasonable transition period is determined on a case-by-case basis, during which time you would continue to see the non-plan provider. The decision as to how long this time will be takes into consideration the severity of your condition and the amount of time reasonably necessary to effect a safe transfer. This will be determined on a case-by-case basis with input from you and the therapist as to when it is safe to transition you to another provider, or into the full service health plan. The Medical Director will be consulted on these decisions. REV: 03-10-23 MI ATTY/AGR.2023.039/Aetna (EAP Services Agreement) (Page 32 of 42)