Magellan on the behavioral health line of your card.
Magellan shows up on the behavioral health side of employer plans, public sector plans and union trusts. Often an employee assistance program sits in front of it with a small number of counseling sessions. That program is a fine first call, and it is not the same thing as the benefit that pays for intensive outpatient care.
Shift is out of network for behavioral health benefits managed by Magellan.
We are not part of any commercial carrier or behavioral health network. What decides your cost is the out-of-network language in your own plan document for intensive outpatient care. We read it, turn it into a weekly figure, and give you the figure before you commit.
What we can say about your plan before we read it.
Covered by many PPO plans. We check your benefits first.
We do not waive cost shares, we do not tell you a number we have not verified, and we do not promise a result. We read your plan, we tell you what it pays toward intensive outpatient care, and you decide after that.
What your plan sets, and what we do about it.
The numbers are not on this page on purpose. Yours are specific to your plan and your plan year, and we pull them with you.
What your plan document sets
- An allowed amount for each kind of visit or day of care.
- A deductible you meet before the plan starts paying its share.
- A coinsurance split that applies after the deductible.
- An out-of-pocket maximum for the plan year.
- An authorization step for intensive outpatient care.
What we do
- Call the behavioral health number on the back of your card and pull the out-of-network figures for the level of care you need.
- Turn those figures into the dollar cost of a week of treatment and give you that number in writing.
- Open the authorization and stay on the case through review and renewal.
- Bill the plan directly, so you are not fronting the claim and chasing a reimbursement.
Two doors, and people only ever find the first one.
An employee or member assistance program usually offers a short run of counseling sessions and a warm handoff. The medical plan's behavioral health benefit is what pays for a level of care above weekly therapy. They are different doors and you can use both.
Use it, then come to us
Tell the counselor you are looking at a virtual intensive outpatient program. Send us whatever they give you and we open the benefit check on the medical plan at the same time.
Check your benefits If your coverage is through a fundThe plan documents are the authority
On a union health and welfare trust the trust document sets the benefit. We read the document rather than rely on a summary, and we tell you what it says.
Union and Taft-Hartley fundsMagellan, answered plainly.
I used my assistance program sessions and I still need more help. What now?
That is the common path to this level of care. The assistance program and the medical plan's behavioral health benefit are separate. We check the second one, which is the one that pays for intensive outpatient care.
Is Shift in the Magellan network?
No. We are out of network for every commercial carrier and every behavioral health administrator. We read your plan's out-of-network terms and give you the number rather than leaving you to find out later.
My coverage is through a public employer. Does that change the process?
Not the process. Public sector plans and union trusts often have their own authorization steps and their own plan documents, so we read the document itself rather than a carrier summary.
Will my employer be told?
We do not report anything to an employer. We cannot control what a plan's own utilization or claims reporting shows a plan sponsor, and we will not pretend otherwise. Substance use treatment records carry the stricter protection of 42 CFR Part 2, which governs what we may disclose and to whom.
Send the card and we read the behavioral health benefit.
Member ID, group number, and the behavioral health phone number from the back of the card. We come back with your out-of-network deductible, coinsurance and out-of-pocket maximum, and what a week of intensive outpatient care would cost you.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service.
Not the card you hold.
Shift also publishes a page for Carelon, Aetna, Cigna, Anthem and Elevance, UnitedHealthcare, UMR, Blue Shield of California, Kaiser and union and Taft-Hartley funds.
Background reading: how out-of-network works, out-of-network for IOP and PHP in plain English, and the program itself.