Behavioral Health/Mental Health coverage can be confusing. Sometimes it is administered by your major medical plan, other times by a separate Behavioral/Mental Health Company.  For example, you may have HealthNet insurance, but your behavioral health benefits might be “carved out” to MHN.

Look on your insurance card or materials provided by your employer.  There may be a separate customer service number on the back of the card for Behavioral/Mental Health.  If there is not a separate number, call the customer service number on the front of your card.  You can also check benefit and provider information online at your insurance company or behavioral health administrator’s website.

Inquire about your outpatient mental health benefits (or inpatient/ hospitalization or substance abuse treatment).  You will want to know how many sessions are covered, what your co-pay will be, whether or not you have a deductible, and if so, how much has been met.  HMO policies do not have a deductible, but may have a co-pay.  Find out if you need pre-authorization to see a psychotherapist.

You may also inquire about Employee Assistance Program (EAP) benefits.  Some workplaces provide a limited number of sessions at no cost to you through the EAP that work similarly to Behavioral Health services.

In-Network vs. Out-of-Network
Some plans will only cover providers who are on their network.  Some plans will allow you to pay a lower co-payment for a network provider than if you see an “out-of-network” provider.  Your plan administrator can tell you who the local contracted providers are, and whether or not your plan has out-of-network benefits.

When no local provider is contracted with your plan, you may request a “single case agreement” or an “accommodation” to see a particular provider.  The person you are talking with on the phone is most likely unfamiliar with our terrain and weather conditions, and may tell you that Ontario is only 30 miles from Big Bear.  In these cases, you can make the argument that in “good faith” you should be able to see a provider within a reasonable distance and safe driving conditions. 

Victims of Crime
Victims of violent crimes may be eligible to have their related expenses, including medical and counseling, covered by the Victim Compensation Program through the office of the District Attorney.  For further information, visit victims.ca.gov or call 1-800-777-9229.