Guide
provided by
http://www.dmhc.ca.gov/
Link
here
Mental Medical Care in California
Mental medical 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 medical care in California can include:
- Diagnostic tests, to identify a mental medical problem
- Clinical and hospital care
- Prescription drug benefits
- Counseling or therapy for individuals, families, and couples
- Group counseling or therapy
How to Get Care with your California medical insurance plan
You can ask for a referral from your primary care doctor, your mental medical care provider, or your medical plan. In some plans, you may be able to make an appointment directly with a mental medical 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 medical provider. Some plans have a behavioral medical care phone number on the membership card. You can call this number.
The Mental Medical Parity Law Protects California Members with Certain Conditions
A medical plan must cover the same or equal benefits for certain mental medical conditions that it covers for other medical conditions. This is called "mental medical 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.
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 Medical 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 medical parity law.
- You can change your doctor or other mental medical 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 medical care rights.
Questions and Answers
- What if my problem is not on the list of mental medical parity conditions?
- How do I get care for a substance abuse problem?
- What if the medicine I need is not covered?
- Does the Mental Medical 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 medical parity
conditions?
You may still be able to
get care from your
medical 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
medical plan to see if
substance abuse problems
are covered. Substance
abuse is not one of the
conditions that must be
covered under the Mental
Medical 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 medical
plan and ask if you can
see a behavioral medical
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
Medical Parity Law cover
children?
Yes. Certain serious
emotional disturbances
in children are covered.
Autism and pervasive
developmental disorders
are also covered.
Will my medical 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 medical 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
medical care. If you are
in a Medi-Cal managed
care plan,
call your plan
or call the Medi-Cal
Mental Medical Care
Ombudsman at
1-800-896-4042.
What if I have
Medicare?
Call your medical plan
and ask what mental
medical care services it
covers. The Mental
Medical Parity Law does
not apply to
Medicare
plans.
Resources
California Network of
Mental Medical Clients
A peer-run advocacy
organization for mental
medical consumers
1-800-626-7447
www.californiaclients.org
California Office of
Patients' Rights
Advocacy for patients
hospitalized with mental
illness
1-916-575-1610
Medi-Cal Mental
Medical Care Ombudsman
Information and help
with Medi-Cal mental
medical care services
1-800-896-4042 (Spanish)
1-800-896-2512 (TTY)
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 Medical
Information and research
on mental medical
treatments
1-866-615-6464 (Spanish)
www.nimh.nih.gov
National Mental
Medical 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 medical
disabilities
1-800-776-5746 (many
languages)
www.pai-ca.org