In general, mental health care provides support and treatment to optimize a person’s emotional and psychological well-being. Treatment for severe mental illness like major depression or panic disorders must be covered by your health plan under the same terms and conditions applied in treating other medical conditions.
If you feel you may have a mental health condition, your first step to receive appropriate care is to request an evaluation from a mental health care provider. Contact your medical doctor or contact your health plan for a list of mental health providers.
The Mental Health Parity Law Protects Members with Certain Conditions
A health plan must cover the same or equal benefits for certain mental health conditions that it covers for other medical conditions. This is called "mental health parity." It is a law in California.
For example, if your plan offers prescription drug benefits, whether drugs are prescribed for a mental health or medical condition, they must be covered at the same rates. The co-payments, deductibles, and maximum lifetime benefits charged for mental health conditions must be the same as those for medical conditions.
The Mental Health Parity Law ensures the same medical care coverage for the following mental health conditions:
- Major depression
- Bipolar (manic-depressive) disorder
- Panic disorder
- Obsessive-compulsive disorder
- Autism or Pervasive Developmental Disorder
- Schizoaffective disorder
- Children's severe emotional disturbances
Know Your Rights
- You have the right to coverage for the diagnosis and medically necessary treatment of severe mental illness under the mental health parity law.
- You can change your doctor or other mental health provider if you are not satisfied.
- You can see and get a copy of your medical records. You can add your own notes to your records.
- You have the right to keep your medical information private.
- You can get a second medical opinion when you are given a diagnosis or treatment option.
- Read more information about your health care rights.
How to Get Care
You can ask for a referral from your primary care doctor, your mental health care provider, or your health plan. In some plans, you may be able to make an appointment directly with a mental health care provider.
Read your Evidence of Coverage (a booklet about your benefits) or call the phone number on your Membership Card to find out what you need to do to see a mental health provider. Some plans have a behavioral health care phone number on the membership card. You can call this number.
Mental health care can include:
- Screening or diagnostic tests, to identify a mental health problem.
- Hospital care, either for a number of overnight days, or just during the day.
- Prescription drug benefits.
- Counseling or therapy for individuals, children, families, and couples.
- Group counseling or therapy.
Health Plan Web Site List for Information About Getting Mental Health Services
You can check your health plan’s Web site for information about mental health services. Click here to locate the Web address.
Types of Mental Health Providers
There are many types of qualified mental health professionals available to diagnose and treat minor to severe mental health disorders. The providers listed below are those trained in different areas of mental health care:
- Psychiatrist - A licensed medical doctor who specializes in the diagnosis, treatment, and prevention of mental illnesses. They may work with you on everyday problems like stress or more complex issues like schizophrenia. Psychiatrists can prescribe medications.
- Psychologist - A licensed specialist who provides clinical therapy or counseling for a variety of mental health care conditions. They have earned a doctorate degree in psychology and are required to complete several years of supervised practice before becoming licensed.
- Counselor/Therapist – A specialist who provides mental health services to diagnose and treat mental and emotional health issues. They may use a variety of therapeutic techniques. Licensed Counselors have a master’s or a doctoral degree in counseling or a related area.
- Neuropsychologist – A licensed psychologist with expertise in how behavior and motor skills are related to brain structures and systems.
- Social Worker - A specialist who provides treatment for social and health problems. Some social workers may work in employee assistance programs or as case managers who coordinate psychiatric, medical and other services on your behalf. Others specialize in domestic violence or chronic illness. Most social workers have a master’s degree in social work; many are licensed as a LCSW.
- Psychiatric Nurse- Licensed registered nurses (R.N.) who have extra training in mental health. Under supervision of medical doctors, they may offer mental health assessments and psychotherapy and they may help manage medications. Advanced practice registered nurses (A.P.R.N.) can diagnose and treat mental illnesses.
- Marriage and Family Therapist (MFT)- Therapists who evaluate and treat disorders within the context of the family. These therapists provide help with a range of problems, such as depression, parent-child conflicts, and eating disorders.
Ask your doctor or health plan for a provider who is qualified and experienced to treat your condition. Some providers may treat only adults. Some providers may treat children and adolescents or certain kinds of mental heath conditions. Some providers may treat patients with severe problems such as schizophrenia and eating disorders and others may only treat patients with less severe conditions.
Mental Health Care for Children
Children may experience a number of disorders, ranging from Attention-Deficit/Hyperactivity Disorder (ADHD) to depression. If not treated properly, these conditions can continue into adulthood.
If you have concerns regarding your child’s mental health, it is best to speak to your child’s primary care doctor first. They may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist, pediatric neurologist, or speech therapist or occupational therapist. However, it's important to have a medical evaluation first to rule out other causes of your child's signs and symptoms.
Another option to receive mental health care to support people with developmental disabilities is to contact a Regional Center. A regional center is a nonprofit, private corporation that contracts with the California Department of Developmental Services to provide or coordinate services. California has 21 regional centers with more than 40 offices located throughout the state.
Some of the services and support provided by the regional centers include:
- Information and referral
- Assessment and diagnosis
- Lifelong individualized planning and service coordination
- Purchase of necessary services included in the individual program plan
- Resource development
- Assistance in finding and using community and other resources
- Advocacy for the protection of legal, civil and service rights
- Early intervention services for at risk infants and their families
- Family support
- Planning, placement, and monitoring for 24-hour out-of-home care
- Training and educational opportunities for individuals and families
- Community education about developmental disabilities
To contact a regional center near you, please visit the following link: http://www.dds.ca.gov/RC/RCList.cfm
Questions and Answers
What if my problem is not on the list of mental health parity conditions?
You may still be able to get care from your health plan. Call the phone number on your Membership Card to find out what services your plan covers.
How do I get care for a substance abuse or addiction problem?
Check your Evidence of Coverage, or call your health plan to see if substance abuse problems are covered. Substance abuse is not one of the conditions that must be covered under the Mental Health Parity law. If substance abuse or addiction problems are covered, you can ask your doctor to refer you for treatment. You can also call your health plan and ask if you can see a mental health care provider without a referral. Ask for a list of providers.
What if the medicine I need is not covered?
Ask if there is a similar drug that is covered that you can try. See prescription drugs. If your doctor thinks you need a drug that is not covered, your doctor must make a special request to your plan. If your plan still says you cannot get the drug, you can file a complaint with your plan.
Does the Mental Health Parity Law cover children?
Yes. The parity law requires coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age. This would include serious emotional disturbances, Autism and pervasive developmental disorders which are frequently identified during childhood.
Will my health plan cover residential treatment?
Ask your plan if residential treatment is covered. A residential treatment center provides long-term treatment and 24-hour supervision for individuals requiring ongoing and a more structured therapy environment. It is usually less restrictive than a psychiatric hospital.
A few questions to ask your provider or your health plan include the following:
- How long could residential treatment last?
- What will I have to pay?
- Where is residential treatment provided?
- What are the names of contracted facilities?
You will need prior approval from your health plan before you or a family member receives residential care treatment. If your plan says the treatment is not medically necessary, you can file a complaint with your plan.
What if I have Medi-Cal?
Medi-Cal provides mental health care. If you are in a Medi-Cal managed care plan, call your plan or call the Medi-Cal Mental Health Care Ombudsman at 1-800-896-4042.
What if I have Medicare?
Call your health plan and ask what mental health care services it covers. The Mental Health Parity Law does not apply to Medicare plans.