November 2023 Monthly Meeting 

Is Parity Working?  Mental Health and Substance Use Disorder Claim Advocacy for Brokers

CE # 387253

Presented by Dede Kennedy

Objectives: 

This is an agent's mental health training course - training brokers on how to assist clients in accessing mental health and substance use disorder treatment and services that are paid for by their insurance. What can and should agents do when clients call with access to care problems? What do we need to know so that we are able and well-trained to help? We'll discuss the following topics:

• Mental Health Fraud, Waste and Abuse
• Mental Health Parity requirements:
  • Including Quantitative Treatment Limits (QTL) and Non-Quantitative Treatment Limits (NQTL)
  • NQTL Analysis requirements
  • Including SB 855
    • Federal
    • California Parity
• Mental Health workforce shortage, treatment deserts and timely access to care implications
• Mental health levels of care 
  • The continuum of care between acute inpatient and outpatient therapy
  • The importance of stepping down or up to different treatment levels
  • Telemedicine - the mental health promise, current reality and impact on workforce shortages and treatment deserts
• Mental Health Coverage - where to find details in SBCs and SOBs
• Mental Health, HIPPA, Authorized Agent and Advance Directives
• Mental health medical necessity
• Coaching clients on navigation of referrals, authorizations, appeals, grievances 
• How to write a mental health appeal
• What is and is not the role of the agent 

About our Presenter:

Dede Kennedy is a 37-year veteran of the healthcare and insurance industries, known nationally for her expertise in employee benefits, and behavioral health. Dede is serving on NABIP's Legislative Council, as well as for a fourth year as Chair of NABIP's Legislative Council’s Mental Health Working Group. The Working Group has two areas of focus – influencing legislation and member education.

Dede draws on her experience as Director of Contracting for a psychiatric hospital where she negotiated with payors for in and out-patient services, trained the admissions and intake departments on how to work with utilization review departments and medical necessity criteria, and developed a behavioral health independent physician association. She also served as a consultant for a non-profit women's substance use disorder treatment facility. In recent years she has navigated her children through 13 admissions to mental health treatment, has over 30 years of experience as a broker of employee benefit plans, has served as an active citizen lobbyist with NABIP and CAHIP, and her background includes a unique experience developing a self-funding mental health and substance use disorder plan, all of which guides the work she does with the Working Group and helping her clients get timely access to care that is funded by their medical plans.

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