Mental Health FAQs


What do I Need to Know to Access Mental Health Care?

 

 

Accessing mental health care usually varies from the process of accessing other medical services.  In fact, most insurance companies contract with a separate company to coordinate mental health care. 

 

Differences to be aware of include:

 

Benefits

Benefits listed on your insurance card--- deductibles and copays—usually apply only to medical services.  It is necessary to call the insurance company to determine if there is mental health care coverage, if preauthorization is required, whether there are deductible and co-pay requirements and if there is a maximum number of visits.  Depending on the plan, out-of-network benefits may or may not be included.  A deductible requirement would be associated with this coverage and then a certain percentage of the fee would be reimbursed following fulfillment of the deductible. HMOs generally do not have out-of-network coverage.

 

Preauthorization

Preauthorization for services is generally required from any company designated by the insurance company to coordinate behavioral health care.  It is the responsibility of the insured to initiate preauthorization by calling the insurance company prior to the first visit.  Preauthorization is usually tied to a specific provider; so if for example, a psychiatrist makes a referral for counseling with a licensed social worker, another preauthorization will be required.  In fact, health care providers working in the same practice may not be covered under the same insurance plans, making preauthorization imperative prior to each visit with individual providers. 

 

Billing

Because the billing address on the insurance card may only pertain to medical services, it is always important to confirm the billing address for mental health care services. 

 

Depending on the type of mental health care required, different mental health professionals may be necessary. 

 

Differences to be aware of include:

 

Psychiatrist:   Psychiatrists are medical doctors who have completed medical school and a residency in psychiatry.  They are able to prescribe medications, assess medical conditions and provide counseling and therapy. 

 

Psychologist:   Psychologists have earned a doctorate degree from graduate school in psychology and have completed post-doctoral internships in clinical care.  While they do not prescribe medicine, they often provide psychotherapy and are generally the only mental health professionals licensed to provide psychological testing.

 

Psychotherapist:   Psychotherapists generally have a Masters level degree in counseling, psychology or social work and more than two years of supervised clinical work. They are licensed by the State as a Clinical Social Worker (LCSW, ACSW), a Licensed Professional Counselor (LPC) or a Marriage and Family Therapist (LMFT).  They provide psychotherapy and counseling services to individuals, families and groups. 

 

 

What are the Differences Between Psychiatrists, Psychologists and Psychotherapists?

 

Differences to be aware of include:

 

Psychiatrist-   Psychiatrists are medical doctors who have completed medical school and a residency in psychiatry.  They are able to prescribe medications, assess medical conditions and provide counseling and therapy. 

 

For a referral to a licensed  and Board Certified psychiatrist in Georgia, you may want to contact the Georgia Psychiatric Physicians Association (GPPA) at www.gapsychiatry.org where an email referral request form is available.

 

 

Psychologist-   Psychologists have earned a doctorate from graduate school in psychology and have completed post-doctoral internships in clinical care.  While they do not prescribe medicine, they often provide psychotherapy and are generally the only mental health professionals licensed to provide psychological testing.

 

For a referral to a licensed psychologist in Georgia, you may want to contact the Georgia Psychological Association which offers a confidential referral line at 404-634-6272.  For more information regarding psychologists in Georgia, visit the Association’s website at www.gapsychology.org.

 

 

Psychotherapist-   Psychotherapists generally have a Masters level degree in counseling, psychology or social work and more than two years of supervised clinical work. They are licensed by the State as a Clinical Social Worker (LCSW, ACSW), a Licensed Professional Counselor (LPC) or a Marriage and Family Therapist (LMFT).  They provide psychotherapy and counseling services to individuals, families and groups. 

 

For a referral to a Licensed Clinical Social Worker, the National Association of Social Workers (NASW) offers an on-line directory at www.naswdc.org/register/default.asp.

 

For a referral to a Licensed Professional Counselor, the Licensed Professional Counselors Association of Georgia offers an on-line directory on their website at www.lpcaga.org.

 

For a referral to a Licensed Marriage and Family Therapist, visit the American Marriage and Family Therapist Association’s on-line referral service at www.therapistlocator.net.



How do I Have Someone Involuntarily Committed for Mental Health Treatment?


 

Involuntary Apprehension and Treatment Proceedings and Standards

 (Statues can be located at Title 37, Chapter 3, Section 1, et seq of the Georgia Code of Law)

 

Georgia law permits a court to order mandatory treatment - either in a hospital or in a community center - if a person poses a danger to himself or others.

 

In order to have someone detained for a mental health evaluation/treatment, one of the following is necessary:

 

Have the person evaluated by a physician, a psychologist, clinical social worker or a psychiatric clinical nurse who can execute a certificate of detainment.  The person will then be transported by an officer of the peace to the appropriate mental health facility.

Or

 

File an application with the community mental health center for a court ordered evaluation of the person. Upon determination of the need for detainment, the community mental health center will petition the court.  The person can then be brought by an officer of the peace to the appropriate facility.

Or

 

File a petition with the Probate Court*. This requires having two family members or other persons familiar with the person and their behavior present. The judge will make a determination and have an Order To Apprehend issued which will result in the person being taken by a peace officer to the appropriate mental health facility. 

Or

 

Call the Police/ Sheriff* who can take the person to be evaluated by a physician or who can make a determination of need for involuntary treatment and transport the person to the appropriate mental health facility. This option should only be used as a last resort, because it puts the ill person in confrontation with armed officers who may not understand the nature of the illness.

 

Before a person can be delivered to an emergency receiving facility for an examination or evaluation by appropriate medical professionals as to any need for involuntary treatment, the observed facts must meet the following standards:

 

 

Inpatient Treatment Standards

 

The person is a mentally ill person, a drug dependent individual or an alcoholic requiring involuntary treatment (i.e. who refuses treatment); and

 

who presents a substantial risk of imminent harm to himself or others as manifested by either recent overt acts or recent expressed threats of violence which present a probability of physical injury to himself or to other persons; or

 

who is so unable to care for his or her own physical health and safety as to create an imminently life-endangering crisis.

 

 

Outpatient Treatment Standards

The person is a mentally ill person, drug dependent individual or alcoholic requiring involuntary treatment (i.e. who refuses treatment); and

 

who is not an inpatient but who, based on the person's treatment history or current mental status, will require outpatient treatment in order to avoid predictably and imminently becoming an inpatient; and

 

who because of the person's current mental status, mental history, or nature of the person's mental illness is unable voluntarily to seek or comply with outpatient treatment.

 


How do I Apply for Social Security Disability?

 

Disability under Social Security is based on your inability to work. You will be considered disabled if you cannot do the work you did for at least one year from the time of your illness/ disability.  Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are "insured" meaning that you worked long enough and paid Social Security taxes.  Supplemental Security Income (SSI) pays benefits based on financial need to low income disabled persons who have not worked enough to be eligible for SSDI.  SSDI includes Medicare coverage after two years.  SSI provides Medicaid insurance, which includes a prescription drug plan. Prescription coverage is in the works for Medicare, but may be limited by the use of formularies and fail-first policies regarding access to certain medications.

In order to apply for Social Security benefits you must provide certain documents including:

the Social Security number and proof of age for each person applying for payments including your spouse and children, if they are applying for benefits;

names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment;

names of all medications you are taking;

medical records from your doctors, therapists, hospitals, clinics and caseworkers;

laboratory and test results;

a summary of where you worked and the kind of work you did (i.e. work history)

a copy of your W-2 Form (Wage and Tax Statement), or, if you are self-employed, your federal tax return for the past year; and

dates of prior marriages if your spouse is applying.

 

 


How do I Initiate an Individualized Education Plan (IEP) for my Child?

 

 

An Individualized Education Program (IEP) is an education plan for a child with a disability who is eligible for special education and related services under the IDEA.  The plan is developed, reviewed, and revised by a specialized team made up of school personnel and parents/guardian. 

 

IDEA defines "children with disabilities" as having any of the following types of disabilities: autism, deaf, deaf-blindness, hearing impairments (including deafness), mental retardation, multiple disabilities, orthopedic impairments, other health  impairments, serious emotional disturbance, specific learning disabilities, speech or language impairments, traumatic brain injury, and visual impairments (including blindness).

 

Step 1. Child is identified as possibly needing special education and related services --either by the school or the parent. 

 

Step 2. Child is evaluated.  Testing will be provided by the school system during regular school hours. If the parents disagree with the evaluation performed by the school system, they have the right to take their child for an Independent Educational Evaluation (IEE). They can ask that the school system pay for this IEE.

Step 3. Eligibility is decided.  Under the law, parents may ask for a hearing to challenge the eligibility decision if they disagree.

Step 4. Child is found eligible for services.  Within 30 calendar days after a child is determined eligible, the IEP team must meet to write an IEP for the child.

Step 5. IEP meeting is held and IEP is written.  Parents and the student (when appropriate) are participants in this meeting. The parents also have the right to invite to the meeting any persons having knowledge or expertise about their child (e.g. therapist).

Step 9. IEP is reviewed.  The child’s IEP is reviewed by the IEP team at least once a year, or more often if the parents or school ask for a review. If necessary, the IEP is revised. Parents, as team members, must be invited to attend these meetings. Parents can make suggestions for changes, can agree or disagree with the IEP goals, and agree or disagree with the placement.  They may also file a complaint with the state education agency.

 Step 10. Child is reevaluated.  At least every three years the child must be reevaluated. This evaluation is often called a "triennial." Its purpose is to find out if the child continues to be a "child with a disability," as defined by IDEA, and what the child’s educational needs are. However, the child must be reevaluated more often if conditions warrant or if the child’s parent or teacher asks for a new evaluation.

*At any time during the process, dissatisfied parents may file a complaint with the state education agency        www.ed.gov

 

How do I Obtain a Medicaid Waiver?

 

A Medicaid waiver is a long-term care program that allows the individual to receive services at home or in the community that would normally only be Medicaid-covered in an institution. A waiver can allow for various services such as (but not limited to): Day habilitation services, Residential training and supervision, Home Health, Respite Care, Personal Support Services, Home modifications, Supported Employment, Emergency Response, Vehicle Adaptation.

 

In the state of Georgia, there are several waivers that cover the mentally disabled, currently the Mental Retardation Waiver Program serves the most individuals. The Mental Retardation Waiver Program (MRWP) states that all candidates must be deemed appropriate for nursing home/institutional care by a physician and the Georgia Medical Care Foundation.  Consideration for the Mental Retardation Waiver is extended to Medicaid eligible mentally retarded and developmentally disabled individuals who are not currently receiving Medicaid benefits under a cash assistance program.

 

To obtain a Medicaid Waiver, one must first contact the Intake and Evaluation Office/Agency assigned to their region (You may find out the contact number of the office by visiting www.thegao.org or calling 800-537-2329). The individual must then obtain an application from the office. The application must be completely filled out and then submitted via fax, mail, or in person. Once the application is received, the office will set a screening appointment, at which time the individual must have present:

 

(1) copies of any previous evaluations by a doctor, psychologist, school(s) attended, or any other document containing information regarding the skills and abilities of that individual, (2) addresses for doctor, psychologist, school, or any other source providing an evaluation, (3) copies of Medicaid, Medicare and/or insurance information,

(4) copies of the individual’s tax return from last year, a recent pay stub, or social security benefit information. If the individual needing the service is under 18, it is required that information about the family’s income must be presented.

 

The individual will be notified IN WRITING about the preliminary eligibility determination within seven working days after the screening appointment.

 

 

 

How to Obtain Mental Health Services if You or Your Child is on Medicaid

 

Beginning in June 2006 persons enrolled in Medicaid and Peachcare will be automatically enrolled in Georgia Healthy Families and served by one of three managed care companies (CMOs). 

What this means is that providers [doctors & hospitals] who used to be covered by your Medicaid plan, may no longer be covered under the new plan.  

Please be aware:

Doctors and hospitals are not necessarily contracted with all three of the CMOs, so it is always necessary to determine whether a provider or facility is covered prior to making an appointment.

Scheduled appointments are required for all non-emergency visits in order to get CMO preauthorization (permission).

To find information regarding providers enrolled with your Care Management Organization (CMO), you may contact the CMO by phone or visit their website for a provider directory.

Georgia Care Management Organization Contact Information

 

AMERIGROUP

P.O. Box 62509 East/ North Region

Virginia Beach, VA 23466-9933

1-888-821-1108

www.amerigroupcorp.com/georgia/

 

WellCare

1-800-546-6814

www.wellcare.com/HealthPlans/Georgia/

WellCare/Medicaid.aspx

 

Peach State Health Plan

3200 Highlands Parkway SE, Suite 300

Smyrna, GA 30082 1-866-874-0633

www.pshpgeorgia.com

Exceptions: Some members are excluded from joining (do not need to join) a health plan and will continue to be served by their current plan. These exceptions include:

People who need special medical services or live in an institution

People in Medicaid who qualify for Medicare

People in Medicaid who are part of an Indian Tribe that the government approves

People who qualify for Supplemental Security Income (SSI)

Children eighteen (18) years of age or younger who are in foster care or another

out-of-state home

Children (18) years of age or younger who are getting foster care or adoption assistance under Title IV-E of the Social Security Administration

Children in the Children’s Medical Services Program

Children in the Georgia Pediatric Program

Children with care coordination by the MATCH program (Multi-Agency Team for Children)

People in Long Term Care

People in the SOURCE program (Service Options Using Resources in Community

Environments)

People in Pre-Admission Screening and Resident Review

People who are getting Hospice care

For more information on the new program or to enroll, contact Georgia Healthy Families at 1-888-423-6765 or visit www.gahealthyfamilies.com

 

 

 

How to Apply for Medication Subsidies


Finding financial assistance in order to obtain medication can be confusing.   Listed below are several websites which can help:

Partnership for Prescription Assistance www.pparx.org offers a single point of access to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. It identifies patient assistance programs for which patients may be eligible based on demographic and financial qualifications and provides downloadable patient applications. 

Needy Meds  www.needymed.com Provides a detailed listing of local, state and manufacturer-sponsored patient assistance programs, including contact and application instructions. 

Rx Assist www.rxassist.org Provides a searchable database containing eligibility requirements and application instructions for pharmaceutical-sponsored patient assistance programs. 

National Alliance for the Mentally Ill www.nami.org/content/contentgroups/helpline1/prescription_drug_patient_assistance_programs.htm  Lists contact information for psychiatry -specific manufacturer-sponsored patient assistance programs.

Together Rx Prescription Savings Program
1-(800)-444-4106                 www.togetherrxaccess.com
The Together Rx Access™ is a free drug card program that offers 25% to 40% savings  on prescriptions for over 275 brand-name drugs for qualified, low-income Americans who are not eligible for Medicare and have no prescription drug insurance.

Please note that all pharmaceutical companies do not offer patient assistance programs and of those which do, assistance may not be offered for all of their medications.

Listed below are some of the more common psychiatric medications for which patient assistance is offered by the manufacturer, along with contact information.

Abilify                                                 Bristol-Myers
1-(800) 736-0003                    www.bmspaf.org

Adderall XR                                            Shire Pharmaceuticals                                                            1-(866) 325-8229                   www.adderallxr.com (click on ADHD Resource Center at the bottom of the page)           

Aricept                                                         Pfizer                                                    1-(800)-226-2072    www.pfizerhelpfulanswers.com                                                                       

Ativan                                                     Wyeth Pharmaceutical                                  1-800-568-9938                           www.wyeth.com/patientassistance

Buspar                                                       Bristol-Myers
1-(800) 736-0003                    www.bmspaf.org

Campral                                             Forest Pharmaceuticals                                 1 (800) 851-0758   www.forestpharm.com/pap         

Celexa                                                        Forest Pharmaceuticals                                 1 (800) 851-0758   www.forestpharm.com/pap

Clozaril                                                  Novartis
1-800-277-2254       www.pharma.us.novartis.com/novartis/pap                 

Cymbalta                                                  Lilly (Lilly Cares)                                        1-(800)-545-6962                  www.lillycares.com

Depakote                                                      1-(800) 222-6885                                            Abbott Laboratories

Effexor                                                 Wyeth Pharmaceutical                                  1-800-568-9938                           www.wyeth.com/patientassistance

EMSAM                                                    Bristol-Myers
1-(800) 736-0003                    www.bmspaf.org    

Equetro                                                        Shire                                                             1-(866)-325-8224                       www.equetro.com (click on Patient Resources in left column)

Eskalith (lithium)
GlaxoSmithKline
1-866-728-4368     www.bridgestoaccess.com

Exelon                                                      Novartis
1-800-277-2254       www.pharma.us.novartis.com/novartis/pap

Focalin                                                      Novartis
1-800-277-2254       www.pharma.us.novartis.com/novartis/pap

Geodon                                                          Pfizer, Inc. (Connection to Care)                                                   1-(866) 776-3700 www.pfizerhelpfulanswers.com

Klonopin (clonazepam)
Hoffman-LaRoche
1-877-75ROCHE (877-757-6243)

Lamictal
GlaxoSmithKline
1-866-728-4368  (1-866-PATIENT)    www.bridgestoaccess.com

Lexapro                                                Forest Pharmaceuticals                                 1 (800) 851-0758   www.forestpharm.com/pap

Namenda                                               Forest Pharmaceuticals                                 1 (800) 851-0758   www.forestpharm.com/pap

Neurontin                                              Pfizer, Inc. (Connection to Care)                    1-(866)-776-3700           www.pfizerhelpfulanswers.com

Paxil (paroxetine)
GlaxoSmithKline
1-866-728-4368  (1-866-PATIENT)    www.bridgestoaccess.com

Prozac                                                           Lilly (Lilly Cares)                                        1-(800)-545-6962                  www.lillycares.com

Razadyne                                                     Ortho-McNeil Neurologics, Inc.                     1-(800)-652-6227              www.razadyne.com (click on Financial Assistance in left column)

Risperdal                                                        Janssen                                                         1-800-652-6227                              www.janssen.com (click on Our Company & then Patient Assistance Programs)

Ritalin LA                                                    Novartis
1-800-277-2254       www.pharma.us.novartis.com/novartis/pap

Seroquel                                                       Astra Zeneca
1-800-424-3727                                          
www.astrazeneca-us.com  (click on Drug assistance in left column)

Strattera                                                               Lilly (Lilly Cares)                                        1-(800)-545-6962                  www.lillycares.com        

Tegretol
Novartis
1-800-277-2254         www.pharma.us.novartis.com/novartis/pap

Trileptal                                             Novartis
1-800-277-2254       www.pharma.us.novartis.com/novartis/pap

Wellbutrin (bupropion)
GlaxoSmithKline
1-866-728-4368  (1-866-PATIENT)     www.bridgestoaccess.com

Zoloft                                                          Pfizer, Inc. (Connection to Care)                                                   1-(866) 776-3700 www.pfizerhelpfulanswers.com

     
Zyprexa                                                           Lilly (Lilly Cares)                                        1-(800)-545-6962                  www.lillycares.com       








 

 

How do Create a Wellness Recovery Action Plan?

 

A WRAP is a written record that allows a person with a mental illness to identify their symptoms, track them daily, and make a plan for treatment in the eventuality that it becomes necessary.  A WRAP allows the person with a mental illness to communicate their wishes regarding treatment to others, even when they are incapacitated by symptoms.  The key factor is that the WRAP is developed during a period that a person feels relatively in control of their symptoms, and it is then distributed to their supporters and updated as needed.

 

Either of the following guides can be used to create a WRAP.

 

The free publication:

 

SMA-3720 Action Planning for Prevention and Recovery :A Self-Help Guide

From SAMHSA National Mental Health Information Center

1-800-789-2647

 

OR,  the ($10)  Wellness Recovery Action Plan book from:

 

Mary Ellen Copeland, MS, MA   

PO Box 301  

West Dummerston, VT  05357
Phone: (802) 254-2092   

Fax: (802) 257-7499

 

It is not difficult to make a WRAP, but it is especially useful if the person creating it has specific wishes regarding the choice of treatment facilities, doctors, or methods of treatment that are acceptable.