Some states require that we notify members or prospective members of certain rights or plan benefits that may apply. Review additional state required notices.

 

California:

Important Notice

 California Health Plans must cover the levels of care described in ASAM* guidelines, including ASAM* 3.1 (Clinically Managed Low-Intensity Residential Services) or ASAM 3.2-WM (Clinically Managed Residential Withdrawal Management). If you received ASAM 3.1 and ASAM 3.2-WM treatment in 2021 at an appropriately licensed facility and are covered by a California Health Plan you may be eligible for reimbursement.

If you received these services, please contact the behavioral health toll-free number on the back of your ID Card to discuss how these services may be paid for if they meet certain eligibility and clinical guideline requirements.

*American Society of Addiction Medicine©

Greater access to mental health and substance use services

OptumHealth Behavioral Solutions of California (Optum) follows the latest California laws that make the California Parity Act stronger. The Act says all CA health plans and insurers must cover the diagnosis and treatment of certain mental health conditions. This is the same as for other medical conditions. The goal is to make sure members have fair access and overall support for behavioral health services.

The California Department of Managed Health Care (DMHC) recently published new changes to the Act that took effect April 1, 2024.

Below is a brief summary of those changes that are now part of your benefits with Optum:

Network Gap Coverage

If you need mental health or substance use disorder services and a network provider is not available in your area or at a time that works for you, Optum will help you access services from an outside provider. Your coverage will be the same as services from a network provider.

Extra Services

You will also be covered for the following services that may be needed to prevent, find, and treat mental health and substance use disorder:

- Assertive community treatment
- Intensive case management
- Intensive home-based treatment

Case Review

DMHC has said what Optum must do in clinical and use reviews:

- When a member can get a certain level of care but medical services or treatment are not available, Optum must approve the next-higher level of care.
- Optum will use Nonprofit Professional Association clinical criteria when it looks at medical needs or uses, and when making decisions about coverage.

California Department of Managed Health Care

 

Assembly Bill No. 1184

Your Right to Receive Confidential Communications Related to Receipt of Sensitive Services

California Law gives members certain rights regarding communications received from health insurance companies and health plans regarding the receipt of sensitive services. The law recognizes the importance of maintaining the privacy of this information for members, including minors, who might be vulnerable if it were shared.

This law ensures that these communications are sent to the person who received the treatment or care instead of the plan subscriber.

The law also gives members the right to request that we send communications in a different format or to a different address.

Sensitive Services Subject to this Law

“Sensitive services” refers to all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender affirming care, and intimate partner violence.

How we will send communications related to your receipt of sensitive services:

If you have designated an alternative mailing address, email address, or telephone number pursuant to the confidential communication process below, we are required to send or make all communications related to your receipt of sensitive services to the alternative mailing address, email address, or telephone number designated.

If you have not designated an alternative mailing address, email address, or telephone number, we are required to send or make all communications related to your receipt of sensitive services at the address or telephone number on file.

Types of communications subject to this law:

The communications subject to this law include the following written, verbal, or electronic communications related to the receipt of sensitive services:

  • Bills and attempts to collect payment.
  • Notices of Adverse Benefit Determinations.
  • Explanation of benefits (EOB) notices.
  • Requests for additional information regarding a claim.
  • Notices of contested claims. 
  • The name and address of a provider, description of services provided, and other information related to a visit.
  • Any written, oral, or electronic communication that contains protected health information. 

 

How to submit a confidential communications request:

Submit your request for confidential communications by completing the form here.

If you have questions about submitting a request, call customer service at the telephone number located on your health plan ID card.

Your request will be valid until you submit a revocation of the request or a new confidential communication request is submitted.

 

Join the committee to help improve your benefits

OptumHealth Behavioral Solutions of California (OHBS-CA) leads a Public Policy Committee, and we are looking for new members.

When you join our committee, which includes mental health specialists from our network, you will:

  • Meet every three months with other committee members
  • Offer suggestions to the Board of Directors for changes to policies and procedures
  • Recommend actions OHBS-CA may pursue to improve the quality of care and service
  • Provide insights and offer suggestions for improving your mental health benefits, in general

 

If you’d like to be a part of the committee, please contact OHBS-CA at carla.arrington@optum.com

 

Colorado:

Emergency and Non-emergency services disclosure

 

Connecticut:

Senate Bill No. 1085

This bill went into effect 1/1/16 and expands the services certain health insurance policies must cover for mental and nervous conditions. By law, a policy must cover the diagnosis and treatment of mental or nervous conditions on the same basis as medical, surgical, or other physical conditions (i.e., parity). Review Senate Bill No. 1085.

Below are the non-traditional behavioral health services included in this bill that Optum will now cover under the outpatient mental health benefit for plans mandated by this bill ie: fully insured commercial plans, sitused in the State of CT and State of CT employees. All of these services do require prior authorization both in and out of network.

  • Intensive, home-based services addressing specific mental or nervous conditions in a child while remediating problematic parenting practices and addressing other family and educational challenges that affect the child's and family's ability to function;
  • Intensive, family- and community-based treatment programs that focus on environmental systems impacting chronic and violent juvenile offenders.

Senate Bill No. 811

Information for Members in Connecticut Insurance Plans: Surprise Bills

Out-of-Network Costs for Members in Connecticut Insurance Plans

 

Indiana:

Member Notice - Good Faith Estimate

 

Maine:

Consumer Notice of Surprise Billing Rights

 

Maryland:

Maryland Mental Health Parity and Addiction Equity Act (MHPAEA) Healthplan Subscriber Notice

For full mental health benefit information please refer to your Certificate of Coverage (COC) and Schedule of Benefits, or contact your healthcare provider. In addition, you may refer to the Maryland Insurance Administration website: http://www.mdinsurance.state.md.us

2018 State of Maryland Behavioral Health Services Expense Forms

2017 State of Maryland Behavioral Health Services Expense Forms

 

Massachusetts:

Access to Community-Based Behavioral Health Service (CBHS) Providers Commercial / Fully Insured

Available CBHS providers that provide crisis, urgent care, and stabilization services, including but not limited to mobile crisis intervention and the emergency services program can be identified by entering community behavioral health centers in the directory search feature and selecting facilities.

Access to Services to Treat Child-Adolescent Mental Health Disorders: Behavioral Health Children and Adolescent (BHCA) Services Commercial / Fully Insured

Beginning on 7/1/2019, the Massachusetts Division of Insurance and Department of Mental Health expanded overall accessibility to specific children’s mental health services to Fully-Insured Commercial Massachusetts-Sitused members. Prior to 7/1/2019, these immediate care and outpatient services were only covered by MassHealth (Medicaid) plans through the Children’s Behavioral Health Initiative (CBHI). Services under the Commercial Insurance plan are now referred to as Behavioral Health Children and Adolescent (BHCA) Services.

Specific information on the services is found in the MA State Bulletin 2018-07: Access to Services to Treat Child-Adolescent Mental Health Disorders.

BHCA services may take place in any community-based setting such as at home, school or out in the community. They are comprised of a wide range of supportive interventions to assure effective coordination and monitoring and include the following:

  • Community-Based Acute Treatment
  • Intensive Community-Based Acute Treatment
  • In-Home Therapy / Family Stabilization Team
  • In-Home Behavioral Services
  • Mobile Crisis Intervention
  • Intensive Care Coordination
  • Therapeutic Mentoring
  • Family Support & Training

 

Not all members are eligible for BHCA services.  Massachusetts-sitused (i.e. where your policy is issued) Commercial Fully Insured Plans must provide these services; some other Massachusetts-Sitused Health Plans have opted to offer these services as a “buy-up” to their Employee Self-Funded or ASO plans. There are multiple variables in determining member eligibility. Members and providers are encouraged to verify member eligibility and benefits prior to rendering any BHCA services.

BHCA services apply to:

  • All youth through the age of 18
  • Fully Insured Commercial Plans
  • Policies sitused in the state of Massachusetts
  • Providers practicing in the state of Massachusetts
  • Both in- and out-of-network providers
  • New or renewing accounts on or after 7/1/2019

 

BHCA services do not apply to:

  • Massachusetts residents whose accounts are not sitused in Massachusetts
  • Non-Massachusetts practicing providers
  • ASO accounts who have not opted to “Buy-Up” for BHCA services

 

Michigan:

The Michigan Department of Health and Human Services has developed a “non-opioid directive form”, which allows patients to voluntarily inform their health care providers that they do not wish to receive opioids, while the directive is in place. Individuals (or legal guardians) who wish to execute such a directive may download and complete the form and give a copy to their health care professionals.

 

New Mexico:

 

New York:

 

Rhode Island

Rhode Island allows individuals or authorized representatives to request that their Protected Health Information (PHI) be sent to the insured individual or authorized representative instead of the primary insured who pays for the enrollee’s health insurance plan. Insured individuals or authorized representatives can request that they be contacted at a specific mail or email address or specific telephone number, as designated by the insured individual or authorized representative.

To submit a confidential communications request pursuant to this law, follow the instructions below:

Submit your request for confidential communications by completing the form here.

Your request will be valid until you submit a revocation of the request or a new confidential communication request is submitted.

 

Virginia:

Balance Billing Protection Notice

 

Washington:

Senate Bill No. 1065

Consumer Notice of Surprise Billing Rights.

 

Senate Bill No. 5889

Your Right to Receive Confidential Communications Related to Receipt of Sensitive Services

Washington Law gives members certain rights regarding communications received from health insurance companies and health plans regarding the receipt of sensitive services. The law recognizes the importance of maintaining the privacy of this information for members, including minors, who might be vulnerable if it were shared.

This law ensures that these communications are sent to the person who received the treatment or care instead of the plan subscriber.

The law also gives members the right to request that we send communications in a different format or to a different address.

Sensitive Services Subject to this Law

“Sensitive services” refers to all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender affirming care, and intimate partner violence.

How we will send communications related to your receipt of sensitive services:

If you have designated an alternative mailing address, email address, or telephone number pursuant to the confidential communication process below, we are required to send or make all communications related to your receipt of sensitive services to the alternative mailing address, email address, or telephone number designated.

If you have not designated an alternative mailing address, email address, or telephone number, we are required to send or make all communications related to your receipt of sensitive services at the address or telephone number on file.

Types of communications subject to this law:

The communications subject to this law include the following written, verbal, or electronic communications related to the receipt of sensitive services:

  • Bills and attempts to collect payment.
  • Notices of Adverse Benefit Determinations.
  • Explanation of benefits (EOB) notices.
  • Requests for additional information regarding a claim.
  • Notices of contested claims.
  • The name and address of a provider, description of services provided, and other information related to a visit.
  • Any written, oral, or electronic communication that contains protected health information.

 

How to submit a confidential communications request:

Submit your request for confidential communications by completing the form here.

To submit a request over the phone, call customer service at the telephone number located on your health plan ID card.

You may also use the form available at https://www.insurance.wa.gov/sites/default/files/documents/confidentiality-request-form_0.pdf and mail it to:

Optum Privacy Administrator, 11000 Optum Circle, MN101-E013, Eden Prairie, MN 55344

Your request will be valid until you submit a revocation of the request or a new confidential communication request is submitted.