Mental Health

You have two ways to submit a claim. Submit payment reimbursement for in-network or out-of-network mental health therapists or other providers one of these ways.

1. Submit a medical claim through the member web portal (submit a claim)
2. Fill out a claim reimbursement request  (PDF document)

Your health plan covers a wide variety of treatment options for diagnoses such as attention deficit hyperactivity disorder (ADHD) and autism.

Applied behavior analysis (ABA) is an effective treatment for individuals with autism, including those who also have ADHD.

ABA uses learning principles to encourage desired behaviors and discourage undesired ones. It is based on the idea that rewarding certain behaviors will increase them, while not rewarding them will decrease them.

ABA can help with a variety of skills, including communication, social interactions, self-care, motor skills, and academic skills. It can be done using different teaching styles.

Medication — Stimulants are the most common type of medication used to treat ADHD, but nonstimulants can also be used.

Occupational therapy — This type of therapy helps with activities of daily living and the use of everyday objects.

Psychotherapy — Behavioral therapy can help people change their behavior. Cognitive behavioral therapy can help people improve focus and concentration.

Speech therapy — This treatment is essential for individuals with autism. It is key to improving communication skills, including speaking, nonverbal skills like eye contact and gestures, and conversation. It may also teach people how to use picture symbols, sign language, or computers to express themselves.

Types of providers

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

Psychiatrists

• Is a licensed medical doctor (MD) or doctor of osteopathy (DO)
• Specializes in mental health and substance use disorder
• Diagnoses and provide treatments such as prescribing medications and providing talk therap
• Manages mental and physical aspects of mental health and substance abuse conditions

Psychiatric nurse practitioners

• Is a licensed nurse with a master’s, postgraduate or doctoral (nursing) degree
• Diagnoses and provides various types of talk therapy for mental health and substance use disorder condition
• Prescribes medications (depending on state regulations)

Psychologists

• Is licensed, with a doctoral degree in psychology (PhD, PsyD, or EdD)
• Diagnoses and provides various types of talk therapy to treat mental health conditions
• Administers tests and evaluates many mental abilities and qualities such as intelligence, thinking, and personality

Clinical social workers, marriage and family therapists, and mental health counselors

• Is licensed and has a master’s or advanced degree
• Diagnoses and provides various types of talk therapy to treat mental health conditions
• Provides individual, group, couples, marriage, and family therapy, depending on areas of interest or specialty

Licensed chemical dependency counselors

• Is licensed and has an associate’s degree, bachelor’s degree, or master’s degree, depending on state regulations
• Provides counseling to treat various substance use disorders such as alcohol, opioids, and illicit drugs
• Provides individual and group counseling for substance use treatment (typically)

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. Sign in to your account and check your benefit details to confirm your plan's coverage.

Levels of care

Substance use and complex mental health conditions (like eating disorders) often need special treatment. Your primary care doctor or a mental health provider can help you find the right care. Your plan might cover the following types of treatment:

Inpatient

• Mental health: A hospital or unit that provides 24-hour care for severe mental health conditions. Some may also treat substance use. The treatment team usually includes a psychiatrist, nurses, counselors, and social workers.
• Substance use: A hospital or unit that provides 24-hour care for severe drug and alcohol problems, including detoxification. The treatment team usually includes a doctor, nurses, social workers, and counselors.

Residential

• Mental health: A live-in facility that provides intensive treatment for mental health conditions with 24-hour support. Some may also treat substance use. The treatment team usually includes a psychiatrist, nurses, counselors, and social workers.
• Substance use: A live-in facility that provides intensive treatment for substance use disorders with 24-hour support. Some may also treat mental health conditions. The treatment team usually includes a doctor, nurses, social workers,and counselors.

Partial hospitalization

• Mental health or substance use: An outpatient program of four to eight hours a day for mental health and/or substance use disorders. It is used as a transition from inpatient treatment or to prevent inpatient treatment. The treatment team usually includes a doctor, nurses, counselors, and social workers.

Outpatient

• Intensive mental health or substance use: An outpatient program of at least three hours a day, three to five days a week for mental health and/or substance use disorders. It is a good option for those who need intensive treatment but want to continue involvement with their job, family, or other responsibilities. The treatment team usually includes a doctor, nurses, and counselors.
• Mental health: Treatment scheduled one to two times a week for mental health conditions that do not need more intensive care.
• Substance use: Treatment scheduled one to two times a week, used as a transition after discharge from a partial hospitalization or intensive outpatient program, or for conditions that do not need more intensive treatment.

Everett

Compass Health
Serves people of all ages with comprehensive mental health treatment, crisis prevention and intervention, supportive housing, children's services, community education, and much more.

Kent

Kent Youth and Family Services
Promotes healthy development of children, youth, and families in South King County by providing professional counseling, education, and support services.

Olympia

Community Youth Services
Provides intensive home and community-based treatment to help 12 to 17 year-olds reduce acting out, stayin their home and school, and decrease their risk of arrest.

Renton

Renton Area Youth and FamilyServices
Supporting youth and families with the resources and support they need to recover from substance abuse, mental health issues, and other serious life challenges.

Seattle

Big Brothers, Big Sisters Puget Sound
Provides children facing adversity with strong and enduring, professionally supported 1-to-1 relationships that change their lives for the better, forever.

Childhaven
Promotes lasting, nurturing bonds between caregivers and their infants. Counseling services support the emotional health and development of children up to the age of 13.

Neighborcare Health
Offers behavioral health services for mental health, help with substance use, lifestyle changes, and more, as well associal work services to any established Neighborcare Health patient.

Sound
Provides over 80 mental health and substance abuse recovery programs for a diverse community—from children to seniors, individuals to families, military to civilians.

Spokane

Catholic Charities of Spokane
Delivers high-quality behavioral health services through individual and group therapy, peer support, and case management. Doesn't denyservices based on a person's race, color, sex, age, national origin, disability, religion, veteran status, gender identity, sexual orientation, or ability to pay.

Shoreline

Center for Human Services
Serves children and adults through three core program areas: Mental health counseling; family support centers; and substance abuse prevention, intervention, and treatment.

Vancouver

Children's Center
Serves children, youth, and families through comprehensive community-based mental health services.

Multiple locations

LifelineConnections
Helps adults with substance use and mental illness find hope and healing with full-spectrum, evidence-based care.

Lutheran Community ServicesNorthwest
Offers services for behavioral health, children and families, refugees and immigrants, aging and independent living, and crime victims.

Pioneer Human Services
Assists people reentering society from prison or jail, as well as those who are overcoming substance use disorders and mental health issues.

Wellspring Family Services
Works from individualized plans to ensure positive outcomes in three core service areas: Emotional well-being, work-life balance,and family and child relationships.

How to file a complaint with the Washington Office of the Insurance Commissioner (OIC)

Please use the OIC complaint form or the toll-free OIC hotline at 800-562-6900. You can also access all reports issued by the OIC at Reports | Washington state Office of the Insurance Commissioner.

Crisis lines

SAMHSA National Helpline (Treatment Referral Routing Service)
Substance Abuse and Mental Health Services Administration
800-662-HELP(4357) - TTY: 711
Help is available in English and Spanish.

Disaster Distress Helpline
Substance Abuse and Mental Health Services Administration
Call if you've experienced a national or human-caused disaster.
800-985-5990 - TTY: 711
Text TalkWithUs to 66746
Help is available in English and Spanish.

National mental health & substance use resources

Anxiety and Depression Association of America
An international nonprofit membership organization that focuses on improving quality of life for those with anxiety, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and co-occurring disorders.

Depression and Bipolar Support Alliance
DBSA offers in-person and online support groups for people living with a mood disorder, as well as their friends and family.

Hazelden Betty Ford
The nation's largest nonprofit treatment provider is a force of healing and hope for individuals, families, and communities affected by addiction to alcohol and other drugs.

Hazelden Betty Ford / Shatterproof Just Five
1 in 3 people is affected by addiction. Just Five delivers—in just five minutes per lesson—the most important concepts and facts about addiction. Learn who's at risk, signs and symptoms that indicate someone may be struggling with a substance use disorder, and more.

Mental Health America
The nation's leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and to promoting the overall mental health of all Americans.

National Alliance on Mental Illness
The nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

National Institute of Mental Health
The lead federal agency for research on mental disorders offers a wealth of mental health information.

Substance Abuse and Mental Health Services Administration
The federal agency has a mission to reduce the impact of substance abuse and mental illness on America's communities. Offers a Behavioral Health Treatment Locator.