Some states require that we notify members or prospective members of certain rights or plan benefits that may apply. Review additional state required notices.
California Health Plans must cover the levels of care described in ASAM* guidelines, including ASAM* 3.1 (Clinically Managed Low-Intensity Residential Services) or ASAM 3.2-WM (Clinically Managed Residential Withdrawal Management). If you received ASAM 3.1 and ASAM 3.2-WM treatment in 2021 at an appropriately licensed facility and are covered by a California Health Plan you may be eligible for reimbursement.
If you received these services, please contact the behavioral health toll-free number on the back of your ID Card to discuss how these services may be paid for if they meet certain eligibility and clinical guideline requirements.
*American Society of Addiction Medicine©
This bill went into effect 1/1/16 and expands the services certain health insurance policies must cover for mental and nervous conditions. By law, a policy must cover the diagnosis and treatment of mental or nervous conditions on the same basis as medical, surgical, or other physical conditions (i.e., parity). Review Senate Bill No. 1085.
Below are the non-traditional behavioral health services included in this bill that Optum will now cover under the outpatient mental health benefit for plans mandated by this bill ie: fully insured commercial plans, sitused in the State of CT and State of CT employees. All of these services do require prior authorization both in and out of network.
For full mental health benefit information please refer to your Certificate of Coverage (COC) and Schedule of Benefits, or contact your healthcare provider. In addition, you may refer to the Maryland Insurance Administration website: http://www.mdinsurance.state.md.us
Beginning on 7/1/2019, the Massachusetts Division of Insurance and Department of Mental Health expanded overall accessibility to specific children’s mental health services to Fully-Insured Commercial Massachusetts-Sitused members. Prior to 7/1/2019, these immediate care and outpatient services were only covered by MassHealth (Medicaid) plans through the Children’s Behavioral Health Initiative (CBHI). Services under the Commercial Insurance plan are now referred to as Behavioral Health Children and Adolescent (BHCA) Services.
Specific information on the services is found in the MA State Bulletin 2018-07: Access to Services to Treat Child-Adolescent Mental Health Disorders.
BHCA services may take place in any community-based setting such as at home, school or out in the community. They are comprised of a wide range of supportive interventions to assure effective coordination and monitoring and include the following:
Not all members are eligible for BHCA services. Massachusetts-sitused (i.e. where your policy is issued) Commercial Fully Insured Plans must provide these services; some other Massachusetts-Sitused Health Plans have opted to offer these services as a “buy-up” to their Employee Self-Funded or ASO plans. There are multiple variables in determining member eligibility. Members and providers are encouraged to verify member eligibility and benefits prior to rendering any BHCA services.
BHCA services apply to:
BHCA services do not apply to: