Month: July 2016

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.