Guest Author - Bonnie Sayers
Recently I received new handbooks for my Health Insurance that included listing of Providers and of Pharmacies. There was an additional book I was not familiar with nor had I ever seen before. This was entitled Member Handbook Supplement and mentioned PacifiCare Behavioral Health.
This plan includes mental health, chemical dependency, treatment of severe mental illness in both children and adults and treatment for children with serious Emotional Disturbance (SED). For the Behavioral Health plan my dependents are also eligible, but getting them added required many confusing telephone calls. Turns out I need to contact my Insurance Plan to get them added for this supplemental plan.
In order to access the PacifiCare Behavioral Health Services I do not have to go through my Primary Care Physician (PCP). I deal directly with PacifiCare to request services for the first time. After that it is up to the Doctor to obtain referrals for further treatment.
The following conditions are listed under severe mental illness in my handbook:
Major Depression Disorder
Obsessive-Compulsive Disorder (OCD)
Pervasive Developmental Disorder, including Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
For the Serious Emotional Disturbance of a child (SED) the child must be under eighteen, display either psychotic features, risk of suicide, risk of violence due to mental disorder or meet the special education eligibility requirements.
The impairments must be present for at least six months, the child has sustained impairment in at least two areas - self care, family relationships, school functioning or function in the community. The child also needs to have one or more of the mental disorders as defined in the DSM-IV-TR.
There are co-payments in this plan. There is direct 24-hour phone access to the services of the plan. They have a wonderful website at www.pbhi.com that explains the difference between a psychologist, psychiatrist and social worker. This is helpful in knowing which type of professional you seek counseling through and if you are in need of medication which one can legally write a prescription. Make sure you inform your Primary Care Physician of any medications you are prescribed through a mental health professional and note these on a medical card in your wallet.
They provide a PacifiCare Behavioral Health Care Coordination Form, call 1-800-999-9585, ext 35760 to request one. There is also a Fax Form Library for professionals to get copies at 1-800-463-1931. Mental Health Screening can be done online.
The Clinician Directory can be searched by city, state or zip and by the name of the Physician. Here is where you can choose what condition you would like to treat. Some of these include:
Cognitive Behavioral Therapy
Gastric Bypass Evaluation
The options for a Clinician include - Masters Level, Psychologist, Psychiatrist or Nurse Masters Level. I searched for someone who was familiar with autism and could also treat me for my anxiety, although I prefer my children to see someone different to treat them for therapy and possible medication management for my younger son.
There is also information on the selections for wheelchair accessibility, public transportation access, evening hours and if they are taking new patients. The languages they speak, weekend appointments, their ethnicity and license information is all there plus the age range for various conditions for children.
He is on an antipsychotic medication (Geodon) for his autism, which is prescribed by a Developmental Pediatrician, who is also on his feeding team at the same clinic. When I inquired last year about adding another medication to his regimen, the Doctor suggested we see a Neurologist to manage his medications. The one associated with his HMO has a long wait list. I decided to try out PacifiCare Behavioral Health to get another opinion on what medications would suit him best.
I called PacifiCare Behavioral Health in December of 2006 to get my choice of a Clinician approved. I had to specicially ask for the approval to start in January, otherwise I would have had to see someone in December as the year was ending and so would the authorization.
I was authorized for four visits to see the Clinical Social Worker I chose. Her specialities include anxiety, OCD, autism, womens issues and parenting issues. I can receive up to twenty sessions per calendar year. My first session will cost me a five dollar co-pay with the rest of the visits set at two dollars each. I believe this is the same price for the dependents coverage.
It will be up to the Clinician whether I need further counseling once I start the process by setting up an appointment. This is a much easier process than dealing with the County Mental Health Deparment in Los Angeles as they send you to areas I would not feel safe going and most are for serious mental illnesses and do not provide counseling.
PacifiCare Behavioral Health also has an ADHD tool kit on their site. The number to call for Depression screening is 1-800-831-3176 and respond to the questions using a touch-tone keypad. Here is a Depression Assessment site that is also available in Spanish.
Other benefits you might have with your Behavioral Health Plan is elder care, pet care, life coaching, legal and/or financial assistance, child care and alternative care. Do not overlook your Employee Assistance Plan that might also have these offerings.
If you are a State Employee you have an Employee Benefits Plan. Those that work at schools, libraries and Banks have them as well. This is usually a benefit that a larger company would offer versus one with only a handful of employees.
Educational Autism Tips for Families 71 page resourceful ebook for families entering the school system with a recent autism diagnosis. Find out what issues take place over the course of a school day and meet these challenges head on.