A Winning Idea Regarding Mental Health Coverage
by Heather Fox BSN, RN

Recently, we had an employer that wanted to make a change to their plan’s mental health coverage. It turns out a member of their group had a sudden onset, high dollar, mental health claim. The employer, through the broker, reached out for help to our underwriter on the group, John Angelo. The employer had come up with an idea to limit coverage for long-term mental health treatment to try and save costs, a logical reaction to the situation. But, when John and I looked into how that would impact the situation, we realized it would result in a higher cost for the group in the long run. Because of this claimant’s type of mental health diagnosis, limiting the long term care treatment would force the claimant to have to access an acute care treatment, at a much larger dollar amount, and at a more frequent rate.

Fortunately, John and I were able to come up with a better solution, not only for the employer, but also for the employee. We suggested they permit long-term mental health treatment within their plan design, but with the assistance of a case manager. Utilizing a case manager would be a win-win. It would reduce the potential of a sudden onset mental health episode by offering preventative assistance to the employee AND it would lower the overall cost to the employer. Everyone was in agreement that this tailored plan was the best approach.

Through collaboration, communication and teamwork, Roundstone was able to meet the needs of the entire group and also achieve cost savings for the employer. 

If you have any questions or would like to learn more about our cost containment strategies, please feel free to contact me at hfox@roundstoneinsurance.com or John at jangelo@roundstoneinsurance.com 440-617-0333. You can also visit our website for more information RoundstoneInsurance.com.


Steve Lechman

 

My name is Heather Fox, I am a graduate of Indiana Wesleyan University with a Bachelor of Science in Nursing and have been a Registered Nurse for 16 years. Prior to my employment at Roundstone, I worked on a Critical Care Unit. I also have previous nursing experience on a Medical Surgical Unit, in an Operating Room and as a Float Nurse. I grew up wanting to help people, and being a part of the Cost Containment Team at Roundstone allows me to continue to do this through my work with the underwriting and claim departments.

 

 

 

 

Steve Lechman

My name is John Angelo, I am a graduate of The College of Wooster with a degree in Mathematics. As an Underwriter, my responsibilities at Roundstone include developing rates and terms for new and renewal business, as well as working with our valued advisors to find creative solutions to their increasing healthcare costs. The best part of my job is working with such a knowledgeable team.

 

 

 

 

Roundstone Management, LTD | 15422 Detroit Avenue, Lakewood, OH 44107 | 440.617.0333 | info@roundstoneinsurance.com | roundstoneinsurance.com