Effective January 2019, all PacificSource Medicare Advantage (MA) plans will consider the specialties below as eligible for our members.
Licensed Professional Counselors (LPC)
Licensed Clinical Professional Counselor (LCPC)
Licensed Marital and Family Therapists (LMFT)
Licensed Mental Health Counselors (LMHC)
We believe with the addition of these provider types, we will better support the Integrated Care Models such as Patient Center Medical Homes, while providing the necessary additional access to care in rural communities.
If you have anyone in your provider group or clinic that meets these credentials, they are now considered as eligible providers to help care for our members even though original Medicare would not reimburse these providers.
For clinics and groups that have an already established PacificSource Medicare contract, claims we receive from these providers will be paid under your existing MA contract rates, as long as these provider types have been credentialed. Members cost share will match benefits under outpatient mental health care as outlined in their Explanation of Coverage (EOC).
For clinics and groups who do not currently hold a PacificSource Medicare contract, but would like to offer care to our members, we encourage you to contact our Provider Service Department.
Some PacificSource MA plans include coverage for Out of Network (OON) providers. Members that have OON benefits on their plan will be responsible for the cost difference between the billed charges and the PacificSource allowed amount, in addition to their normal cost share.
Example – Provider charges $150.00.PacificSource allowed amount is $95.00.Member benefit for OON outpatient behavioral health services is a 50% coinsurance.In this scenario, PacificSource will pay $47.50, making the total member responsibility $102.50 ($47.50 coinsurance + $55.00 over PacificSource allowed).
If you are interested in additional information regarding obtaining a Medicare Advantage contract, or have any questions, please feel free to reach out to our Provider Service Department at: