How the Program Works for CAP Members
CAP members have the option of seeking care through ValueOptions' network of providers or seeking care with non-network licensed providers. Although there may be a difference in the out-of-pocket cost to members, there is no difference in the level of benefit. No outpatient care requires pre-approval or referral by ValueOptions. Should you need their assistance in finding a provider, however, ValueOptions will be happy to give you names of network providers appropriate for your situation and your geographic location. Although no outpatient care requires pre-approval or referral by ValueOptions, all care — whether it's provided by a network or non-network provider — 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 inpatient care or Alternate Levels of Care (partial hospitalization, residential treatment, and intensive or structured outpatient care). To obtain authorization, contact call 800-562-3588 to speak with a ValueOptions (VO) care manager who will coordinate your case.
Whether you elect to receive care from a network or non-network provider, 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.
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 with a network provider, the ValueOptions Access Team can also help you. Call the toll-free number and let the care manager know you need help.
If you receive care from a network provider, you do not need to fill out claim forms. The provider will send the claim directly to VO for payment. If you receive care from a non-network provider, you may 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)."
For more information on medical management and the authorization process, see "Medical Management and Authorization Programs."
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.