Mental Health and Substance Use Disorder treatment services for members on Washington medical plans
Providence Health Plan will cover, without prior authorization, emergency behavioral health services¹ provided by a behavioral health emergency services provider², as defined in RCW 48.43.005, whether the provider is a participating or non-participating provider.
Classification of mental health and substance use disorder treatment and access standard
Mental health and substance use disorder treatment services are characterized as specialty services when provided by behavioral and/or mental health professionals. Washington law requires that members have access to mental health or substance use disorder treatment services within 15 business days.
Resources for persons experiencing a mental health crisis
- Suicide Prevention Hotline
The Suicide Prevention Hotline is 800-273-8255.
- Emergency Resources
If this is an emergency or you think you may harm yourself, call 911.
Resources for substance use disorders
How members can find in-network mental health and substance use disorder treatment and services in their service area
You can find in-network providers by visiting our Provider Directory, available online at http://phppd.providence.org/ or calling Customer Service at 800-878-4445 to get information about a mental or behavioral health provider’s participation with Providence Health Plan and your benefits.
Steps a member may take if they cannot access services in the required timelines
If you are having trouble making an appointment, please call 800-878-4445 to speak with an intake specialist who will help you identify your needs and, if needed, facilitate an individualized appointment search.
How members may file a complaint with WA OIC
- Disciplinary action for failure to meet network access standards (no action against Providence Health Plan) (link coming soon)
- Washington Office of the Insurance Commissioner annual access standards and consumer complaints report (link coming soon)
Additional information regarding behavioral health services and resources are available to Providence Health Plan members via Live and Work Well. To access these resources, Providence Health Plan members sign into myProvidence located at https://myprovidence.com. From there, members click on the behavioral health link located on the benefits tab.
¹The Emergency Services definition was amended to now include services provided after an enrollee is stabilized and as part of observation or stay with respect to the visit during which screening, and stabilization services have been furnished.
The Emergency Medical Condition, definition was amended to now mean a medical, mental health, or substance use disorder condition manifesting itself by acute symptoms of sufficient severity.
Post Stabilization Services relate to medical, mental health, or substance use disorder treatment necessary in the short term to avoid placing the health of the individual in “serious jeopardy.”
²Behavioral Health Emergency Services Provider, is defined as any provider of emergency services provided in a crisis stabilization unit, evaluation and treatment facility, behavioral health agency certified by the department of health, or a crisis triage facility. Additionally, mobile rapid response crisis teams contracted with a behavioral health administrative services organization is included in this definition.