Mental Health Care
Mental health care is care for emotional or behavioral problems. The problem may be short-term, like depression after childbirth, or it can be long-term, like manic depression or autism.
Mental health care can include:
- Diagnostic tests, to identify a mental health problem
- Clinical and hospital care
- Prescription drug benefits
- Counseling or therapy for individuals, families, and couples
- Group counseling or therapy
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.
Types of Mental Health Providers
There are many types of qualified mental health providers. These include clinical psychologists, social workers, marriage and family therapists, nurse practitioners and psychiatrists. There are also hospitals and other kinds of treatment centers that specialize in mental health and developmental disabilities.
- 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 problems.
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.
If you have prescription drug benefits, drugs for these conditions must be covered at the same rates. The co-payments, deductibles, and maximum lifetime benefits for these conditions must be the same as those for medical conditions.
The Mental Health Parity Law protects people with these conditions:
- Major depression
- Bipolar (manic-depressive) disorder
- Panic disorder
- Anorexia or bulimia
- Obsessive-compulsive disorder
- Autism
- Schizophrenia
- Schizoaffective disorder
- Children's severe emotional disturbances
- Pervasive developmental disorder
Know Your Rights
- You have the right to treatment for certain conditions 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 records private.
- You can get a second opinion about your diagnosis or treatment.
- Read more information about your health care rights.
Questions and Answers
- What if my problem is not on the list of mental health parity conditions?
- How do I get care for a substance abuse problem?
- What if the medicine I need is not covered?
- Does the Mental Health Parity Law cover children?
- Will my plan cover residential treatment?
- What if I have Medi-Cal?
- What if I have Medicare?
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 behavioral 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. Certain serious emotional disturbances in children are covered. Autism and pervasive developmental disorders are also covered.
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. It is usually less restrictive than a psychiatric hospital.
Ask how long residential treatment lasts and what you will have to pay. Ask where residential treatment is provided. You will need prior approval from your health plan before you receive 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.
Resources
California Network of Mental Health Clients
A peer-run advocacy organization for mental health consumers
1-800-626-7447
www.californiaclients.org
California Department of Developmental Services
California agency that provides services and support to people with developmental disabilities such as mental retardation, cerebral palsy, epilepsy, autism and related conditions.
(916) 654-1690
(916) 654-2054 (TTY)
http://www.dds.ca.gov
California Department of Mental Health
California's public mental health system with services and information available to adults and children.
1-800-896-4042
1-800-896-2512 (TTY)
http://www.dmh.ca.gov
California Office of Patients' Rights
Advocacy for patients hospitalized with mental illness
(916) 575-1610
Medi-Cal Mental Health Care Ombudsman
Information and help with Medi-Cal mental health care services
1-800-896-4042 (Spanish)
1-800-896-2512 (TTY)
www.dmh.ca.gov/Ombudsman_Services/default.asp
National Alliance for the Mentally Ill (NAMI)
An advocacy group for people with mental illness and their families
1-800-950-6264 (Spanish)
www.nami.org (Spanish)
National Institute of Mental Health
Information and research on mental health treatments
1-866-615-6464 (Spanish)
www.nimh.nih.gov
National Mental Health Association
Information, advocacy and referrals for adults and children
1-800-969-6642 (Spanish)
1-800-433-5959 (TTY)
www.nmha.org
Protection & Advocacy
Information on the rights of people with mental health disabilities
1-800-776-5746 (many languages)
www.pai-ca.org