A guide to mental health and substance use disorders.
If you or a loved one is actively suicidal or experiencing a mental health emergency, call 911 or go to your nearest emergency room.
Mental health describes the state of our psychological, emotional, and social well-being. Mental health affects how we feel, think, and interact with the world.
Substance use disorders occur when a person uses substances even though it causes harm to themself or others. The disorders can range from mild to severe and can develop from the use of almost any type of substance including alcohol, marijuana or other drugs, prescription medicines, or over-the-counter medicines.
It can be challenging to navigate care for mental health and/or substance use. This guide aims to help you better understand mental health and substance use disorder benefits available with the Surest health plan.
Clinical Advocacy
Surest clinical advocates can help you:
- Understand your treatment options
- Find in-network facilities and providers to meet your needs
- Coordinate care transitions between treatment centers and outpatient care
- Locate helpful resources and support options, both local and online
Request a call or email from our Clinical Advocacy team.
Care options
Psychotherapy and mental health office visit
This type of care includes talk therapy and counseling with a psychologist, counselor, social worker, or other mental health specialist to support your mental and emotional well-being. These professionals don’t manage medications. Visits can be experienced in a few ways:
- In-person: You see the provider in the office for a mental health visit. Find a provider and view your copay for an in-person visit using the Surest app. Search “mental health therapy” and then click “find providers” to locate a provider near you.
- Telemedicine visit: A video-based visit with a mental health provider. This provider may also see you in person. The copay for a telemedicine mental health visit with your provider will be the same as an in-person visit. Find a provider and view your copay using the Surest app. Search “mental health therapy” and then click “find providers.”
- Virtual mental health visit: A virtual-only visit with a mental health provider. Find a provider and view your copay for virtual therapy using the Surest app. Search “virtual mental health therapy” and then click “find providers” to see virtual providers available.
Psychiatric evaluation and medication management
This is mental health support that involves evaluation, therapy, and medication management from psychiatrists. Psychiatrists can evaluate, diagnose, and treat mental health conditions, as well as prescribe and change medications to support your treatment plan. Find a provider and view your copay using the Surest app. Search “psychiatry” and then click “find providers” to locate a provider near you.
Medical office visit
A primary care provider can check your physical health. Search “medical office visit” using the Surest app to compare copays, with high-value providers often assigned lower copays. Your cost for in-network, routine urine and blood tests is $0.
Substance use disorder clinic
These clinics are dedicated to the treatment of opioid use disorder addiction using methadone and other forms of medication-assisted therapy. To find a clinic near you and copays, search “substance use disorder clinic” in the Surest app to see the per visit copay at a clinic.
Intensive outpatient program (IOP)
IOP is an outpatient program designed for those with mental health and/or substance use disorders. Typically, this is three hours per day, two or more days per week. It’s not an overnight program.
You may have access to a virtual IOP program for teens and young adults at risk for mental health crises. This 10- to 12-week-long intensive program includes multiple sessions per week of individual, family, and group therapy, all conducted remotely.
View your benefits and find an IOP program with copays using the Surest app. Search “intensive outpatient treatment program” to see available options. Copay applies per day.
Partial hospitalization program (PHP)
PHP is an outpatient day program designed for those with mental health and/or substance use disorders. The duration is typically five days per week, four to eight hours per day. It’s not an overnight program .
View your benefits and find a PHP program with copays using the Surest app. Search “partial hospitalization program” to see available options. Copay applies per day.
Residential care
Residential care is a treatment program in a live-in health care facility for mental health and/or substance use disorders. The program generally lasts for one month or longer.
View your benefits and find a residential care program with copays when you search “residential treatment facility care” in the Surest app. The copay is for the duration of your stay (from admission to discharge).
In-patient care
In-patient treatment for mental health and/or substance use disorders is 24/7 care in a hospital or facility. It’s typically a short-term stay, less than 30 days, for acute mental health or substance use disorder treatment.
View your benefits and find an in-patient care facility with copays when you search “in-patient mental health and substance use disorder care” in the Surest app. The copay is for the duration of your stay (from admission to discharge). If acute or subacute detoxification is needed during the stay, it will be included in the copay for your stay.
Out-of-network care
You may have out-of-network benefits for care. The Surest app doesn’t include out-of-network providers or locations. Choosing to go out-of-network may cause your costs to increase, incur balance billing, and require you to manage prior authorizations. To view your coverage for out-of-network benefits, check your Summary of Benefits and Coverage document in the Surest app. From your account home page, select “Your plan” and then “Plan resources.”
Prior authorizations
Some mental health and substance use disorder care will require a prior authorization for admission to the program. The in-network providers will contact Surest to initiate this process.
If you’re seeing an out-of-network provider, you'll need to ensure a prior authorization is requested. Contact Member Services at the number on the back of your Surest member ID card with questions.
Resources
- 988 Lifeline: Call or text if you or someone you love is having suicidal thoughts. Available 24/7 for free and confidential support.
- Surest Clinical Advocacy: Fill out this form for questions and support
- National Alliance on Mental Illness (NAMI)
- Substance Abuse and Mental Health Services (SAMHSA)
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This content is not medical advice. You should always consult with your health care professional.