Obtaining Behavioral Health and Substance Abuse Care

A member who needs a behavioral health referral may contact Health Net directly, without a referral from their primary care physician (PCP) or participating physician group (PPG). Members should refer to their identification card for the phone number. The member's PPG or employer group Employee Assistance Program (EAP) counselor may also make the referral to behavioral health services advising the member to contact the Member Services number listed on the back of the member’s ID card.

Member Services is available 24 hours a day, seven days a week. Licensed clinical care managers and customer service representatives are always available for referrals, benefit inquiries and crisis intervention.

• Crisis intervention: A clinical crisis is defined as when a member presents a situation involving imminent danger to self or others, or suspected grave disability. A grave disability is when a member demonstrates severely impaired judgment as a result of psychosis or other psychiatric condition leading to inability to manage self-care safely. The clinical care manager is responsible for assuring that the crisis evaluation is arranged and must make follow-up contact to confirm that the emergency face-to-face evaluation was conducted and the disposition is in place according to Health Net's accessibility and follow-up standards. Health Net has licensed behavioral health clinicians available for phone crisis intervention, stabilization and referrals
• Routine: If the situation is not defined as emergency or urgent, the customer service representative assesses the member's needs, geographic area, benefit plan and scheduling requirements to determine the type and location of providers available to meet those needs. The customer service specialist then conducts a provider search and furnishes the member with several referrals from which to choose. Member preferences and needs, such as gender, linguistic and cultural experience, are seriously considered. After receiving referrals, the member calls providers directly in order to schedule an appointment

When medication or quality of care is in question, the clinical care manager may arrange for a second opinion by another psychiatrist.

• Urgent: After assessing the situation, the clinical care manager either provides referral information to the member or, as necessary, may assist with scheduling an appointment.