How the Program Works for NAP Members
NAP members have the option of seeking care through ValueOptions' network of providers and receiving higher network benefits, or seeking care with non-network providers and receiving lower non-network benefits. Neither network nor non-network outpatient care requires pre-approval or referral by ValueOptions, although all care, whether network or non-network, must be Medically Necessary. See "Medically Necessary."
While you do not need authorization or approval for outpatient care, there is a $300 penalty for not obtaining authorization for both inpatient care and Alternate Levels of Care (partial hospitalization, residential treatment, and intensive or structured outpatient care). Inpatient care and Alternate Levels of Care (partial hospitalization, residential treatment, and intensive or structured outpatient care) must be authorized within 48 hours of the beginning of confinement or treatment to avoid a $300 for failure to obtain authorization. To obtain authorization, call 800-562-3588 to speak with a ValueOptions (VO) care manager who will coordinate your case.
Whether you elect to receive network or non-network care, VO care managers are available 24 hours a day, seven days a week to assist you. Your case will be confidential, except as otherwise provided by law or as noted in any paperwork you may complete.
Care managers are qualified, licensed professionals, including psychologists, psychiatric social workers, marriage and family counselors and registered psychiatric nurses. The care manager can assess your particular situation and concerns, and discuss various treatment options with you. They can also help you find appropriate network providers in your area.
For more information on medical management and the authorization process, see "Medical Management and Authorization Programs."
Network Benefits
For NAP members, the Mental Health, Alcohol and Drug Care Program provides maximum benefits when you use network providers. You may call ValueOptions at 800-562-3588 to obtain a list of providers in your area and have your treatment authorized.
You may also find network providers yourself by accessing ValueOptions' website for PG&E members at www.achievesolutions.net/pge. When you first access the site, select "About Services," and then "Find Services." Then select "Referral Connect" under "Mental Health." You can use various selection criteria, such as geographic location and provider's specialty, to help find an appropriate provider. Should you need assistance with establishing an appointment, the ValueOptions Access Team can help you. Call the toll-free number and let the care manager know you need help.
Remember, you receive network benefits only when you use a network provider. If you receive network care, you do not need to fill out claim forms. The provider will send the claim directly to VO for payment.
In Case of Emergency
If you or any of your covered dependents require emergency treatment and/or a hospital admission for a mental health condition, your first concern should be to seek professional help immediately. Then contact VO within 48 hours to request network benefits for the emergency treatment.
Non-Network Benefits
Neither outpatient mental health nor outpatient alcohol and drug care require authorization from ValueOptions. You will, however, receive the lower non-network benefits for any non-network outpatient services that are covered by the Program. You may also need to pay the provider and then fill out and submit a claim form to VO in order to receive reimbursement for any benefit to which you are entitled. See "Filing a Claim for Benefits" under "Claims and Appeals Process for ValueOptions (VO)."