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Insurance companies ignore mental health and substance abuse claims

Ignoring claims a company policy

In my attempts to provide mental health and substance abuse treatment for adult men, I have uncovered a concerted effort by insurance providers to circumvent the funding for such treatment by ignoriing valid mental health and substance abuse claims which infact is something far worse than denying claims because by actually ignoring or not processing said valid claims you prevent any appeals and subsequent reimbursement by medicaid. This not processing is infact a actual violation of state law . Where the law clearly states that all valid claims must be processed either denied or approved within a reasonable amount of time. This violation of the law led to me filing a complaint against this provider with the state insurance commissioner. Their response being they had no actual jurisdiction over the insurance provider as they fell under federal jurisdiction as medicare and medicaid contractors. They offered to file a complaint on my behalf with the federal medicare board. The actual ignoring of the claim is far worse than simply denying it. A denial could be appealed and then turned over to medicaid for reimbursement. Since mental health and substance abuse treatment is mandated by the affordable care act the denying of these claims has no merit. So by just not processing the claim it results in the non funding of the treatment provider which serves as a extreme disservice to the clients who need treatment the most. With opioid deaths at a all time high as well as mental health caused mass death currently in the news. Not to mention the mental health and substance abuse caused homelessness at all time highs across the country. The need for more not less mental health and substance abuse treatment is clear and its the insurance providers service of their bottom line instead of their clients that demands our immediate attention. In my research I have uncovered that insurance providers recieve monthly alottments for each medicare and Medicaid client they cover. This alottment is provided whether the client uses the funds or not. Therefore it serves their bottom line to deny or ignore claims submitted on behalf of these clients. In speaking with an attorney that is famillar with these issues he stated the insurance providers have adopted the ignoring mental health and substance abuse claims as a policy as they will only pay when they are forced to through a law suit. In those cases they will pay the litigants and sign a non- disclosure agreement and ignore all the other claims they have denied or ignored. Thus preventing the flood gate of valid claims from being addressed. This is a actual company policy. This serves as a serious disservice to all those who suffer from mental health and substance abuse illness. It also serves as a disservice to the country as a community and all the hard work that went into passing the Affordable care act. We all our affected by the actions of the mentally unstable and serve witness to the extremely high tolls for opioid related deaths.
Our only action at this time to put the bright light of acknowledgement on the insurance industry. To scream with our loudest voicet of the injustice being extolled on those who suffer from mental health and substance abuse illness. We all are touched by this disservice in one way or another. If not us then whom , if not now then when. It remains the duty of those with a voice to speak on behalf of the voiceless. Helping someone other than myself is a mandate inwhich I have made a life mission. I would ask all those that feel the same to join me in proclaiming the disservice being orchestrated by the insurance companies and make an all-out effort to right this most serous wrong.

Please voice your concern and join our email list so we can update you on this topic.

Insurance companies ignoring Mental Health
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NC DHHS fails miserably at administering residential treatment facilities .

The core element of the Affordable Care Act is community healthcare. The only community element for mental health and substance abuse treatment is community residential mental health and substance abuse treatment facilities. These facilities represent the best case avenue for mental health and substance abuse comprehensive treatment for adults and youth in North Carolina. The 27 g treatment facilities is a godsend when it comes to comprehensive MH/SA treatment by the DHHS. The policy and procedures guiding these facilities is resolute in its approach to providing forward thinking, progressive, innovative and all encompassing mental health and substance abuse treatment for adults and children in the state of North Carolina. It is however devastatingly sad that the hierarchy of the DHHS does not even know what a 27 g treatment facility actually is. In fact, we have internal documents that state Jay Ludlam, the head of Medicaid expansion in North Carolina and his team actually believe a 27 g treatment facility is a .5600 group home and does not have the authorization to treat and bill for mental health and substance abuse treatment. I would ask Mr. Ludlam to refer to the DHHS policy and procedures for 27 g treatment facilities, where he would discover that the entire premise for the creation of the 27 g treatment facilities was for the comprehensive treatment of mental health and substance abuse exclusively. A simple and free google search would satisfy anyone’s knowledge of this matter and avert there lack of not knowing. This ignorance is highly troubling when we are questioning the ignorant or intentional overlooking of administration of the much needed community residential treatment facilities as created by the DHHS to address the mental health and substance abuse crisis we have been experiencing in North Carolina for years now.To make matters worst is the fact that Sandhills does not even possess a method to process a UB04 claim form, which is the only acceptable claim form permitted by Medicaid and Medicare for residential treatment facilities. Even more troubling is the fact that with the flood of funding being sent to North Carolina from the federal government for mental health and substance abuse treatment , this funding is not reaching the one program designed and created by DHHS specifically for community health services. The 27 g treatment program on its sheer ability to address specifically the scourge of mental illness and the flood of fentanyl now being spread across our state remains the premier treatment service offered by the DHHS for the communities of North Carolina. It is extremely sad that thru inept, ignorant and dysfunctional administration this exceptional program is failing miserably to assist the most needy of our community. The still sick and suffering desperately need a functional residential treatment program that operates one person,one bed, one day at a time to treat the illness they suffer from. All attempts to put this issue in the spotlight has failed, including correspondence with the head of the DHHS and the Governor. It remains our forever prayer that this issue has a resolution.

Transnet Group of Companies

Transnet Home Group is one of a number of Transnet Companies. The Transnet companies include Transnet Consulting a software internet web site creator with a host of clients. Our latest project is Outstanding Online, a public review website that promotes only verified products and opportunities. We buy what we promote. All our opportunities are tried and income producing. All our products are verified as legitimate and actually work as promoted. We welcome all our visitors to reply on our onsite blog as to the validity of the products and opportunities we promote.
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Transnet Home Group is the premier home provider in North Carolina. At Transnet Home Group we specialize in providing homes for those in need of one family homes as well as those in need of total care as clients in our group homes. We define home for the individual

Our business mandate is to provide the best home and the best environment for our clients. This is accomplished thru our total life style care provision for our group home clients and thru our more bang for the buck foreclosure properties for our one family home clients. The goal in both arenas is to provide the best opportunity for our valued clients.

At Transnet Home Group we follow the Medicare 40% rule for more information on this rule please reference.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Index.html

STATUS OF MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT

In my attempts to provide mental health and substance abuse treatment for adult men, I have uncovered a concerted effort by insurance providers to circumvent the funding for such treatment by denying and infact something far worse than denying claims and that is the actual ignoring or not processing said valid claims. This not processing is infact a actual violation of state law . Where the law clearly states that all valid claims must be processed either denied or approved within a reasonable amount of time. This violation of the law led to me filing a complaint against this provider with the state. Their response being they had no actual jurisdiction over the insurance provider as they fell under federal jurisdiction as medicare and medicaid contractors. They offered to file a complaint on my behalf with the federal medicare board. The actual ignoring of the claim is far worse than simply denying it. A denial could be appealed and then turned over to medicaid for reimbursement. Since mental health and substance abuse treatment is mandated by the affordable care act the denying of these claims has no merit. So by just not processing the claim it results in the non funding of the treatment provider which serves as a extreme disservice to the clients who need treatment the most. With opioid deaths at a all time high as well as mental health caused mass death currently in the news. Not to mention the mental health and substance abuse caused homelessness at all time highs across the country. The need for more not less mental health and substance abuse treatment is clear and its the insurance providers service of their bottom line instead of their clients that demands our immediate attention. In my research I have uncovered that insurance providers recieve monthly alottments for each medicare and Medicaid client they cover. This alottment is provided whether the client uses the funds or not. Therefore it serves their bottom line to deny or ignore claims submitted by these clients. In speaking with an attorney that is famillar with these issues he stated the insurance providers have adopted the denying and ignoring mental health and substance abuse claims as a policy as they will only pay when they are forced to through a law suit. In those cases they will pay the litigants and sign a non- disclosure agreement and ignore all the other claims they have denied or ignored. Thus preventing the flood gate of valid claims from being addressed. This is a actual company policy. This serves as a serious disservice to all those who suffer from mental health and substance abuse illness. It also serves as a disservice to the country as a community. We all our effected by the actions of the mentally unstable and serve witness to the extremely high tolls for opioid related deaths.
Our only action is to put the bright light of acknowledgement on the insurance industry. To scream at our highest level of the injustice being extolled on those who suffer from mental health and substance abuse illness. We all are touched by this disservice in one way or another.

Please voice your concern and join our email list so we can update you on this serious problem.

Insurance companies ignoring Mental Health
Add your voice to the voiceless

Completing this form confirms you wish to receive email communications. You can securely opt-out at any time. I agree to give Transnet home group permission to send me future emails. I understand I can opt-out at any time in the future.

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Transnet Home Group First Time Home Buyers Program

We overcome hurdles of Credit score, Down Payment, Budget, Home Finder

Transnet Home Group operates a First-time home buyers’ program to help individuals overcome the hurdles they face as first-time home buyers. These hurdles include Credit scores, Income budget, Down payment, and finding an affordable home.
We overcome each of these hurdles with a proven method of success.
We then have linked up with several down payment programs where we provide the information you need to acquire down payment funds for your dream home.
We also provide listings of foreclosed property available in North Carolina which we will purchase, rehab, and present for sale at a discounted price to our clients.
Each of these hurdles will be overcome and your path to be a homeowner will be cleared with success being the object and mission of Transnet Home Group First Time Home Buyers Program.

With the slow increase in the prime rate buying a home is becoming more expensive. However, the real estate market is still super-heated. Purchases are being made with all cash and at a premium. Buyers are actually offering bonuses to ensure they get the property they want. Looking for that perfect home should begin with a prerequisite of having your down payment money assured and ready to drop as soon as you locate that perfect home. Making sure you have your real estate agent on speed dial as well as your closing attorney. You have no time for slow responses from anyone on your team.
 

Learn more about the First-time homebuyers’ program


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