CALIFORNIA MEDICAL
Mental Health

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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?
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

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