Patient Advocacy & Cost Containment

MINES’ managed behavioral health services are a cornerstone of our commitment to employee support, wellbeing, and mental health. With over three decades of proven success, MINES has consistently led the way in delivering managed care services that prioritize the complex needs of individuals while also promoting workplace wellbeing and work-life balance.

Our comprehensive approach includes state-of-the-art case management and population health management solutions. We have a long-standing track record of providing cost-effective care in medically necessary settings, resulting in substantial savings for our self-insured clients without compromising the quality of care delivered to each patient.

MINES achieves this through a proactive and highly effective complex case management protocol. This protocol ensures direct communication with patients and their families, addressing crucial aspects such as treatment costs, facility expectations, pre-certification requirements, concurrent review, discharge planning, and long-term aftercare. By offering these key components, we empower individuals to navigate their mental health journey with confidence, ultimately contributing to enhanced employee support, mental wellbeing, and overall workplace wellness. Key components include:

At MINES, our foremost commitment is to ensure that each patient receives the precise level of care tailored to their unique needs. Our dedicated Case Managers step into the role of staunch advocates for patients, guiding them through the intricate array of services available, ultimately facilitating a seamless and effective healthcare journey.

MINES takes pride in its pivotal role in guaranteeing that patients receive the precise and medically necessary structures of care aligned with their unique healthcare needs. Our commitment extends beyond just the initial phases of care, as we stand ready to provide comprehensive aftercare support for as long as the patient requires it.

Our approach to ensuring the patient’s wellbeing encompasses a holistic and patient-centric perspective. We collaborate closely with healthcare providers and patients alike, advocating for the most appropriate treatments, therapies, and interventions tailored to the patient’s condition. Our Case Managers serve as dedicated guides, helping patients navigate the often complex landscape of healthcare services, ensuring that they receive the care they need when they need it.

MINES employs two core strategies to effectively manage costs. Firstly, when it comes to inpatient care, we focus on meticulously managing the entire treatment episode. Our primary aim is to ensure that patients receive the necessary care they require without falling victim to predatory facilities or well-intentioned but ultimately ineffective or inefficient providers.

Secondly, we extend our cost management efforts to outpatient care by leveraging our extensive national PPO specialty network. Through this network, MINES is able to offer substantial discounts, thereby providing valuable cost savings for our clients seeking outpatient services. This dual approach underscores our commitment to delivering cost-effective solutions while maintaining the highest standards of care.

In light of the evolving landscape shaped by changes in the Mental Health Parity Act, there has been a concerning proliferation of predatory out-of-network facilities. These facilities have been capitalizing on their out-of-network status, resulting in the imposition of exorbitant fees for all services. What once may have been a cost range of $10,000 to $30,000 has seen an alarming surge to an astonishing $150,000 to $1,000,000 per treatment episode. Regrettably, such facilities often lack proper aftercare, exhibit high relapse rates, and have been associated with unethical or fraudulent billing practices.

MINES, recognizing the urgency of addressing this issue, has developed robust and proactive case management protocols. These protocols are specifically designed to navigate and manage situations involving such facilities. Our dedicated team works diligently to refer patients to more suitable and appropriate treatment facilities whenever possible, aiming to ensure that patients receive the care they need while avoiding the pitfalls associated with predatory practices.

MINES collaborates closely with the medical plan utilization review and case management teams, forging a strong partnership aimed at enhancing the overall patient experience. Given the inherent uniqueness of each behavioral health and substance abuse case, it is imperative to establish a seamless transition between the realms of medical and behavioral health within the context of case management. This synergy enables consistent and effective communication between the two facets, thereby facilitating the coordination of care that is essential for optimal healing and progress.

Furthermore, MINES extends its collaborative efforts by integrating with on-site clinics, pharmacy benefits, and pharmacogenetic testing partners. These strategic partnerships and the exchange of crucial data contribute significantly to enhancing the capacity of all stakeholders to deliver more effective individual and population health management. The ultimate goal is to ensure that every patient receives the highest level of care and support, fostering improved overall health and wellbeing.

Individuals dealing with chronic illnesses such as addiction or psychological diagnoses like bipolar disorder face enduring challenges throughout their lives. Recognizing the enduring nature of these conditions, MINES offers continuous case management support to patients, with no additional cost burden on the organization. It is widely acknowledged that these conditions may entail recurrent relapses and challenges in adhering to treatment plans.

MINES plays a pivotal role in providing a safety net for individuals grappling with these conditions, helping them stabilize their lives and facilitating their return to their families and communities. The overarching goal is to achieve this transition with minimal disruption and expense, prioritizing the individual’s wellbeing and successful reintegration.

The Proof is in the Data

The opioid epidemic has sky rocketed out of network costs. MINES has been proactive in implementing aggressive case management protocols designed to get treatment for the patient while significantly reducing costs per treatment episode.

For example, prior to these protocols, predatory facilities were charging between $2,000 to $4,000 per day for UAs. On a 30 day stay, the cost for these UA tests alone would reach $60,000 to $120,000.

Under MINES the cost was dropped to $80.00 total for an initial UA and a discharge UA at usual and customary prices. Further significant savings were also realized through our other case management protocols.

For questions regarding these services, to utilize these services, or to request a quote, please contact MINES and Associates at 1-800-873-7138 or Email Us and a MINES Team member will be happy to assist you.