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Mental health/substance use disorder – treatment facilities

Inpatient, residential, intensive outpatient and partial hospitalization services can be covered under HealthChoice when medically necessary. You can find network treatment facilities by using our Provider Search feature on our website located at Select Specialty and then search by Mental Health/Substance Abuse Facility. 

Some inpatient facilities provide mental health services or substance abuse services only, or they may provide both. Some facilities may also have age and/or gender restrictions. Please reach out directly to the facility or visit their website to see which service they provide and to whom. In addition, each facility can only treat a limited number of patients at any one time. Due to limited space, members are encouraged to contact the facility’s admissions office to see if beds are available. While HealthChoice does not require a referral from your provider, you may contact your provider for assistance with getting admitted. Facility admission staff will work with your provider to obtain an order for admission to the treatment facility. 

HealthChoice understands that finding the right treatment facility is critical and can often be an urgent need. If a member has become a danger to themselves or others, please contact 911 or go to the nearest emergency room. If you need assistance in locating a treatment facility, please contact our Care Management team, Careways, at 855-445-1471 or the HealthChoice Health Care Management Unit at 405-717-8879 or toll-free 800-543-6044 ext. 8879.

Network providers are responsible for obtaining certification for inpatient, residential, intensive outpatient and partial hospitalization services. 

Some non-network treatment facilities are not eligible for any reimbursement under the plan. The facility must be licensed by the state and must be Medicare-certified or nationally accredited with an organization such as CARF or The Joint Commission. If not, you may be held responsible for paying the full amount. HealthChoice will assist you in verifying this for non-network providers. 

If you choose to use a non-network provider, you should ensure that the provider obtains certification prior to receiving services. This will ensure that the services being rendered are medically necessary as determined by the plan. Non-network providers are not contracted with HealthChoice and have not agreed to accept allowable amounts. This means you are responsible for paying the difference between the amount the provider bills and allowable amounts. This process, known as balance billing, can be a large amount of money out of your own pocket. Even after you reach your plan’s out-of-pocket maximum, you are still responsible for all amounts above allowable amounts when you use non-network providers. 

Last Modified on Aug 23, 2021
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