How the Program Works for HMO and Kaiser EPO Members
For all HMO and EPO members, any outpatient substance abuse care benefits provided through ValueOptions are available only when you obtain authorization from ValueOptions. You must see VO network providers for all outpatient treatment to receive any benefit. All inpatient or Alternate Levels of Care (partial hospitalization, residential treatment, and intensive or structured outpatient care) require authorization.
To obtain authorization and receive benefits, call 800-562-3588 to speak with a ValueOptions (VO) care manager who will coordinate your case.
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.
Although you need authorization from ValueOptions for all outpatient treatment, you may also browse through ValueOptions' network of 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 in establishing an appointment, the ValueOptions Access Team can assist you. Call the toll-free number and let the care manager know you need help.
Remember, you receive outpatient benefits only when you use a network provider and when your care is authorized by ValueOptions.
For more information on medical management and the authorization process, see "Medical Management and Authorization Programs."