Occasional sadness is a natural part of being human. Depression is different because sometimes a person won't necessarily feel sad; instead, other symptoms and even physical symptoms can be present. If it continues for too long and left untreated, major depression can set in. Fortunately, there is help for you and your loved ones.
Behavioral health resources and assistance for Western Health Advantage members are available through Human Affairs International of California (HAI-CA), a subsidiary of Magellan Health Services. Below you will find an abundance of information including resources about depression prevention programs through Magellan (HAI-CA) that are offered at no additional cost to Western Health Advantage members.
Note: If you are a UC employee, you have access to a variety of behavioral/mental health resources and assistance through Optum.
How to use your behavioral health benefits:
- No referral from your Primary Care Physician (PCP) is required.
- A WHA member can call Magellan or Optum directly.
Magellan Health Services Optum (UC employees)
To find a mental health provider, search Magellan Health Services' provider directory www.magellanassist.com. Use the new or unregistered user option and enter WHA's toll-free number: 800.424. 1778. You do not have to register to begin your search.
Things to remember when making an appointment:
Ask about copayments. A copay is a charge that you are required to pay out of pocket for a specific service. For instance, you may have a $20 copay for each office visit. In the past, copays for mental health visits may have been greater than those for most medical visits. That should no longer be the case for insurance plans subject to the *parity law.
Ask about your deductible. A deductible is the amount that you must pay out-of-pocket before WHA makes any payments. Depending on your deductible, for instance, you may have to pay $500 or even $5,000 out-of-pocket before WHA will begin making payments on claims. As a result of the *parity law, your deductible should apply to both mental and physical health coverage.
Talk to your provider. When you call to schedule an appointment with a mental health provider, ask if he or she accepts your WHA insurance.
Coordinating medical and mental health services. Given the complex relationship between the physical health and mental health, communication and coordination between medical and mental health providers is crucial to safe and quality care. Ask your mental health provider about the importance of coordinating your mental health care with your medical treatment plan.
*The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.
Behavioral Health Prevention Programs
Clinical depression is recognized as one of the major health concerns facing our nation. For this reason, WHA and Magellan (HAI-CA) have joined efforts to develop Depression Prevention Programs for WHA members. The programs are compliant with the National Committee for Quality Assurance (NCQA) standards and focus on enhancing the delivery of preventive health through depression screening after:
- A new mom delivers to screen for postpartum depression—Postpartum Depression Prevention Program
- A medical event such as a heart attack, cancer or stroke
Overall Goal: The overall goal of the prevention programs is the early identification of those who are or may be at-risk for depression; to decrease the level of depression and the length of the illness through early treatment and education about depression.
Program Services: The Prevention Programs provide outreach services conducted by a licensed behavioral health care manager (CM). Some of the program services include:
- Telephonic outreach to all referrals provided by WHA each month
- An initial assessment by the CM to ascertain current status and support systems
- Education as to when behavioral health services should be sought
- Access to a licensed behavioral health care professional on a 24/7 basis, as needed
Postpartum Depression Prevention Program
The focus of this program is the newly delivered mother of a newborn child. Postpartum depression is not an uncommon condition after delivery. This program provides the resources to help you understand why some women experience what is commonly known as "the baby blues" and how to deal with the symptoms.
Depression Screening After a Medical Event
This prevention program focuses on WHA members ages 18 + years of age identified with a medical condition (i.e. diabetes, asthma, cardiac issues, chronic pain, cancer, etc.) who are at risk for depression. The program provides support and resources to help you as you recover from a medical event or hospital stay.
Don’t delay! Get help immediately! Go to the nearest hospital or call 911.
If you or your family member has a mental health or substance abuse problem that is an emergency seriously threatening your life or health, get help at once. You should do one of these things:
- Call 911
- Go directly to an emergency room
- Call your doctor or therapist for help
If you have a mental health or substance abuse problem that is not an emergency, but you think you need to talk to someone right away, call Magellan Customer Service at 800.424.1778 - 24 hours a day, seven days a week. For UC enrollees, contact Optum at 888.440.8225.
If your emergency results in an inpatient admission, you or your provider must notify WHA, as soon as it is reasonably possible, in order to precertify your care.
Four tips to help you be stress-free
When physical symptoms of stress and anxiety are interfering with your daily life, it is important to seek help through your doctor or a behavioral health professional. Many people have success with combinations of:
- Learning more about it
- Talking with a counselor
- Exercising or walking
- Doing relaxation techniques such as progressive muscle relaxation, meditation or time management
Last review date: January 29, 2016