Why Your Health Insurance Carrier Should Not Provide Your Employee Assistance Program

Aug 2, 2017
EAP Insights

By 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) predicts mental health and substance abuse disorders will surpass all physical disease as the leading cause of disability worldwide.

With this ever-increasing focus on mental health, employers are turning to cost-effective solutions like Employee Assistance Programs (EAPs) to help manage issues ranging from employee stress and depression to workplace violence and crisis.

However, not all EAPs are the same. With so many varieties, it’s often hard for buyers to navigate the choices. One option that may seem appealing is the embedded EAP product offered by most health insurance carriers.

These bundled products have become increasingly popular, but don’t necessarily meet the needs of participants or their employers. Why? EAP is not health insurance. EAP services are not a carrier’s core competency or priority. While these embedded programs come with a low price tag, they are also accompanied by numerous disadvantages that may not be apparent to many buyers.

Here are a few reasons why your health insurance carrier should not provide your EAP:

A carrier EAP isn’t really an EAP at all.

Most people think of EAP as simply a counseling and work-life balance resource for individuals. That’s just one piece of the puzzle. A true EAP also provides expert supervisor coaching, performance management and high-level workplace support (i.e. threat assessment, crisis debriefing, training, drug-free workplace, etc.).

Most carriers do not provide these critical resources. So, when dealing with a difficult or urgent workplace issue, it’s likely a carrier will not be positioned to help.

Carrier EAPs offer limited front-line expertise, clinical support and participant advocacy.

First, carriers often route initial EAP intake calls to customer service representatives with little to no clinical expertise. Therein lies a missed opportunity to quickly address participant needs and provide in-the-moment support. Next, most carrier EAPs only provide phone assessments and referrals instead of traditional, face-to-face counseling. Further, most carriers don’t assist participants in getting connected to appropriate long-term care resources. Instead, they provide lists of treatment providers for participants to research themselves. Finally, most carriers provide little follow-up or support to ensure participants are connected to necessary resources. As a result, participants become overwhelmed and ultimately fall through the cracks.

A carrier EAP typically covers only those employees enrolled in the health plan.

Remember- people don’t leave their problems at the door when they come to work. Troubled employees interact with your customers and prospects. Troubled employees are often distracted and disengaged. They make mistakes and cause accidents. They impact office morale. An employer needs a good EAP available to all employees, regardless of the health plan they select.

A carrier is not incented to resolve issues within the framework of the EAP.

A large percentage of issues commonly brought to an EAP can be resolved within the scope of the program. This directly translates to cost savings since the EAP helps employers solve problems early and avoid unnecessary mental health claims. However, this goes against a carrier’s business model and presents a conflict of interest. After all, they are in the business of long-term medical and mental health support, and are motivated to send referrals to their network of providers.

Carriers do not actively promote the EAP.

Since carriers offer their EAP product as an add-on, they don’t usually invest the time and money into managing and promoting the program. The result? No program visibility, utilization or reporting. No relationship. No impact.

Carrier EAPs are limited with respect to customization.

Since EAP is a workplace intervention resource, it should tailor its services to an employer’s unique and specific needs. However, because carrier EAPs are bundled with other insurance products, there are few (if any) options for customization. As a result, an employer must adjust its workflows and needs to the carrier’s one-size-fits-all approach.

Carrier provider networks are limited.

Carriers use the same provider network for EAP and behavioral health care. There is no requirement placed on EAP-specific expertise or training. This is a problem since EAPs focus on short-term problem solving with an emphasis on workplace performance. EAP methodology is unique and requires a clinical approach that is much different from other mental or behavioral health work. Further, provider data is often outdated and many providers go years without a referral. Finally, many carriers make it complicated for providers to receive payment. As a result, many EAP providers have stopped participating in any carrier network.

Mental health is an important topic and a big expense for employers. Since EAPs are an effective resource for tackling costly mental and behavioral health issues, it makes business sense to invest in a quality program.

Rather than looking to your insurance company, consider a specialty or stand-alone provider that is solely focused on providing individual, supervisor and workplace services that drive real results and a positive participant experience along the way. For a deeper conversation on how your organization can benefit from a stand-alone EAP, reach out.

Post Written by

Director, Business Development

Lesley has extensive experience consulting on employee assistance programs (EAPs) and continues to develop concrete solutions for organizations across various industries and sizes. Through her involvement and dedication, she provides valuable insight on how EAP programs can be effective and impactful for organizations and individuals.