Specialized mental and behavioral health services are provided under a single program available to employees enrolled in the state’s medical plan. This program is administered by Optum Behavioral Solutions, also known as United Behavioral Health (UBH) Optum provides 24-hours-a-day, seven-days-a-week phone assessment and referral services for a variety of behavioral health issues, such as:
- Anger management;
- chemical dependency;
- Compulsive disorders;
- Marital and family issues;
- Serious mental illnesses; and
Also, the following services are available to members with a medical diagnosis of Autism Spectrum Disorder.
- Clinical Therapeutic Intervention administered by or under the supervision of a qualified/approved provider, in accordance with an approved applied behavioral analysis (ABA) treatment plan, for up to 20 hours per week.
- Mental and behavioral outpatient services performed by a psychologist, psychiatrist, physician or board-certified behavior analyst who is licensed/qualified/approved provider for consultation/assessment/development/oversight of treatment plans.
- ABA services must be pre-certified. Treatment that is not pre-certified may result in no coverage.
- ABA services are limited to 20 hours per week, including services provided for a consultation/assessment/development/oversight of ABA treatment plans.
The amount the plan pays for covered services is based on the contracted allowed amount. If an out-of-network provider charges more than the contracted allowed amount, you may be responsible for the difference between the billed amount and plan contracted allowable amount.
Example: If an out-of-network hospital (facility) charges $1,500 for an overnight stay and the contracted allowed amount is $1,000, you may have to pay the $500 difference, which is called balance billing.
Contact Optum before receiving services to ensure the highest level of benefits or review the Behavioral Health Benefits Summary Plan Document tab for more information on the benefits.