After July 1, can we refer NT19 SMI members with Medicare or TPL to a Medicare/TPL doctor in their network (outside the T/RBHA system)?
For any non-TXIX SMI member with TPL, including Medicare, the T/RBHA should bill the TPL first, as the state is the payer of last resort. If a member, of their volition, chooses to disenroll from the T/RBHA and seek all behavioral health services through their TPL, that is the member’s choice. However, the member should be informed that he/she is entitled to certain benefits as a result of their SMI eligibility, including set co-pays of $3. Because the co-pay through the T/RBHA system is likely lower than that through the TPL, the member may prefer to receive services through the T/RBHA system. T/RBAHS must not compel the member to disenroll and receive services through their TPL.
Related Questions
- How do I contact the Visiting Nurse Service of New York to find out about the amount of service Medicare or Medicaid will cover or to have my doctor refer me?
- How often do members refer their friends to join TheSingleEvent.com Network Groups?
- Can members go to a vision care provider outside of the Spectera network?
