Mental Health and Chemical Dependency

  • Your first stop is your primary care provider

    Finding the best psychiatrist or therapist—a general term for all mental health providers—for your personal needs can be challenging. Premera is here to help.

    Finding a mental health professional

    Your search for the best mental health professional isn’t always easy. If you have a primary care provider (PCP), they can evaluate and treat you for any physical causes of your ailments. Discussing these concerns with your PCP can help them guide you toward the right mental health provider.

    Strategies and resources

    Many of our members find a therapist through a referral—a friend, teacher, doctor, or by internet research. Depending on the provider, you may find they specialize in working with specific populations, such as elderly, adolescents, children, or married couples.

    Remember, it's not uncommon to meet with a couple of therapists before you find a good fit for you. Feeling comfortable with your therapist is important for the success of the treatment.

    Chemical dependency, substance abuse, and complex issues

    Chemical dependency or substance abuse, eating disorders, and complex mental health illnesses often require focused treatment. Your primary care physician or any mental health provider can help direct you to appropriate care.

    Your plan might cover:

    • Inpatient: A hospital, state psychiatric hospital, or in Washington state, a designated Treatment and Evaluation facility. Some admissions require prior authorization from your health plan.
    • Residential treatment center: A live-in healthcare facility that provides care for substance abuse, mental illness, or other behavioral health issues. Admissions require prior authorization to be covered.
    • Partial hospitalization: A structured program of outpatient care, usually 4 to 6 hours a day. This works well for those who are transitioning from an inpatient stay or trying to prevent hospitalization. This treatment is less intensive than inpatient care and more intensive than care at a therapist's office.
    • Intensive outpatient treatment: An outpatient program that provides structure and an intensive level of care. This is a good option for those who need intensive treatment, but want to ensure they can continue with job, family, or other responsibilities while addressing their addiction or mental illness.
    • Outpatient: Scheduled appointments, usually once or twice a week with your care provider. Good option for people who are motivated to address their addiction or mental health and don't need a more intensive form of treatment.

    Eating disorders: Bulimia and anorexia

    People who have been diagnosed with eating disorders have benefits available to help understand nutrition and the effects of their eating disorder. Nutritional therapy is covered on many plans with no member out-of-pocket expense when services are provided in network. Techniques to identify root cause and avoid binge eating are provided.

    Getting help for a loved one

    When a friend or family member has a major addiction issue, it's not uncommon for loved ones to stage an intervention to convince the individual to get help.

    Before doing this, it's important to have a plan in mind, which includes lining up a treatment center or program. Due to privacy laws, we can't give you information about your loved one's health without his or her permission. However, if you know your loved one's medical benefit plan name, we can answer questions about in-network treatment providers.

    Right to privacy for minors

    In many states, including Washington state, minors 13 to 18 may receive care for mental health or substance abuse without consent from parents or guardians.

    Premera is mandated to respect these rights to privacy as defined by law.

    Explanations of benefits for members 13 or older will be mailed to the member who received the care. This means parents or spouses might not be able to see claims through the online member account or speak to customer services representatives about these claims unless the member grants permission to family members.

    Types of providers

    There are several types of providers and licenses can vary by state. Here's a general idea of who does what.

    • Are medical doctors with specialized training in mental health or substance abuse conditions
    • Diagnose, treat, prescribe, and manage both the mental and physical aspects of behavioral health
    • Treat some of the more severe and complex behavioral health conditions
    • Specialize in psychiatric care; have advanced master's degrees
    • Use talk therapy, medication, or a combination of both treatments
    • Can diagnose, treat, and prescribe medication related to mental health conditions
    • Have doctoral degrees in psychology, and focus on treating mental health or substance abuse conditions
    • Take care of people with mood and anxiety disorders and talk through issues
    • Provide tactics to manage issues, perform testing to diagnose illness; however they don't prescribe medications
    • Have master's degrees and are licensed to treat patients with either mental health or chemical dependency
    • Can perform clinical evaluations, provide therapy, and refer clients to resources. They do not prescribe medication.
    • Use therapy focused on changing behavior, understanding and dealing with emotions, or learning how to cope. This often includes identifying triggers and working on solutions.
    • Marriage and family therapists are mental health professionals trained in psychotherapy and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples, and family systems.
    • Treat a wide range of clinical problems including depression, anxiety and issues within the context of the family
    • Services are covered when the identified patient has a covered mental health diagnosis and marriage and family therapy is included in the patient's treatment plan.
  • Some members prefer to work with a therapist who isn't in network or doesn't take insurance. If your plan includes out-of-network provider coverage, you can submit a request for reimbursement of services.

    Check your benefit booklet to confirm your plan's coverage.