The process for you to start getting help is broken into three steps.
If you think you need help, get started now.
Find out if you are eligible for Medicaid services.
The Department of Social Services in your county can tell you if you qualify for Medicaid. If you receive Social Security Insurance, Special Assistance to the Blind, Work First Family Assistance, or Special Assistance for the Aged or Disabled, you are automatically eligible for Medicaid.
If you are not eligible for Medicaid, Call 1-888-235-HOPE (4673) to see if state-funded services are available to you.
Next, choose a behavioral health care provider.
When you call Partners, a licensed professional will ask you some questions to determine what issues you are having. Based on your answers and your eligibility, we will give you a list of behavioral health care providers who can help you.
You have the right to choose and change your provider at any time. From the list, you tell us who you want to see. And we will help you schedule your first appointment.
If you ever want to search our entire network of providers, use the Provider Search Tool.
Attend your appointment
At your first appointment, your new health care provider will identify the problems you are having with your behavioral health. You and your provider will determine what care or treatment you want to start. Then, just like an insurance company, Partners will agree to pay your provider for the services you need.
You are now on your way to treatment and recovery. Partners, your service providers and a number of other community organizations are there every step of the way. If you have any questions or concerns, call us anytime at 1-888-235-HOPE (4673).
Eligibility for services is determined by medical necessity. This means you receive behavioral health care services intended to correct or improve mental health, substance use disorders, or intellectual/ developmental issues found by an assessment. An assessment is any evaluation by a doctor or licensed clinician. These healthcare services must be
- Necessary to treat the specific issues.
- The most appropriate service for the individual’s needs.
- Based on past effectiveness known as evidence-based practices or best practices.
- The least restrictive treatment available.
- The most efficient service available.
Learn more about medical necessity by calling 1-888-235-HOPE (4673).
The Utilization Management (UM) Department ensures everyone has equal access to right care across the areas we serve. UM authorizes services which meet specific guidelines so the help you get
- Supports recovery.
- Reflects enrollee preferences.
- Is efficient and cost effective.
- Occurs in the most appropriate and least restrictive setting.
- Is consistent with medical necessity criteria.
- Promotes evidence-based practices.
Look at the benefit grids Utilization Management uses to make decisions on services in benefit plans.
Click here to learn about your rights to appeal if your choice of service is denied, reduced, suspended, or terminated. You may also call Partners’ Appeals Unit at 704-884-2650.