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Active Members Information: Mental Health & Substance Abuse

Summary

Optum [formerly United Behavioral Health (UBH)] provides mental health and substance abuse rehabilitation treatment services, whether inpatient or outpatient. (Inpatient detoxification services will be coordinated by Optum but services are provided through your PPO, HMO or Bronze Health Coverage, when clinically necessary.)

Optum provides a specialized network of professional providers and treatment facilities, which have been thoroughly evaluated according to comprehensive guidelines. Optum network providers have not only fulfilled specific selection and credentialing criteria, but are as committed to your health and well-being as any health plan provider.

With the Mental Health and Substance Abuse Program you should experience lower out-of-pocket expenses and no claim forms as long as you use Optum in-network providers. However, you have the freedom to receive eligible mental health services from out-of-network providers, but at a lower level of benefit coverage.

Obtaining Network Care

• Please contact Optum at 1-800-924-0105. You will speak to a trained counselor who will gather basic information to understand your situation and needs.
• Based on the information you provide, the counselor will refer you to the best-qualified mental health or substance abuse professional located near your place of work or home. You will be able to get an in-person appointment, normally within 72 hours; sooner if your condition warrants.
• After your initial meeting(s), the mental health or substance abuse professional will discuss your needs and treatment goals with an Optum counselor and an individual treatment plan will be developed.
• Your treatment will be based on the individual plan developed by you, your mental health or substance abuse professional and the Optum care manager. It may include short-term outpatient counseling; more intensive, structured outpatient counseling; day-treatment programs, inpatient residential care; or hospital care. During your treatment, an Optum care manager will monitor your progress and work with your provider to ensure that your needs are met.

For more information, refer to your Summary Plan Description or contact PEBTF.

Optum www.liveandworkwell.com