Background
Rula began accepting therapy and psych patients who were insured with Cedars-Sinai Medicare Advantage (assuming risk on behalf of Blue Shield 65 HMO) in Fall 2023 and patients who were covered by Kaiser Permanente: Southern California’s Medicare Advantage Plan in Spring of 2024.
Program expansion
Rula now accepts therapy-only clients with Medicare Advantage/Medicaid Plans for the following insurance providers:
Medicare Advantage
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California
- Anthem
- Carelon
- PIH Health (assuming risk on behalf of various MA plans)
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Georgia
- Anthem
Medicaid
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Hawaii
- Rula is running a small Medicaid pilot with Kaiser HI and we're continuously expanding our partnership network and the types of insurance we work with.
On the Medicare Population
Medicare beneficiaries primarily consist of people over the age of 65 but also include some people who are under 65 with certain conditions or disabilities. These patients can encounter a limited pool of providers as not all providers are eligible to treat Medicare beneficiaries or bill Medicare for services. Expanding our services to this patient population is a continuation of Rula’s mission to make mental healthcare work for everyone. Thank you for working with us to provide critical care to these patients!
Psych Referrals
Rula has expanded therapy and psych care to patients in California with Cedars-Sinai Medicare Advantage (MA) insurance through a Blue Shield plan. Inform your patients who are seeking to add psych that they must make an additional request for a psych referral from Cedars-Sinai.
We are not currently able to offer psych for other Medicare Advantage plans with other insurance providers.
Duration of care
The following patients need referrals from their insurance carrier in order to start treatment with Rula. After signing up, they receive an initial referral for a designated number of sessions:
- Cedars-Sinai Medicare Advantage patients receive up to 12 sessions
- Kaiser SoCal Medicare Advantage patients receive up to 16 sessions
All other payers that Rula is accepting Medicare Advantage patients from will not require referrals.
What’s not in-network
At this time, all other traditional Medicare, Medicare Advantage, and Medicaid plans outside of the insurance payers listed above are out of network at Rula at this time. Patients with Medicare, Medicare Advantage, and Medicaid who are not in-network should be referred back to their insurer for in-network providers.
FAQs
Who can see Medicare Advantage clients?
All providers who wish to see these patients at Rula must log in and complete the Fraud, Waste, and Abuse (FWA) course in Workramp before doing so. See these article for more information:
Additionally, providers may not see these clients if they have "Opted-Out" of Medicare
How much will I get paid to see these clients?
Compensation will be the same when treating Medicare Advantage as it is for commercial clients. If you have additional payment questions, please reach out to the Accounts Payable team at AP@rula.com.
Will I still get paid for missed appointments?
Although Medicare Advantage clients are not charged no-show fees, Rula will still pay therapists when this happens. Simply fill out the missed appointment note as you normally would!
Medicare terms
Click here to review the terms for Medicare Advantage at Rula.