Medica contracts with United Behavioral health (UHB) to provide and coordinate all mental health/substance abuse (MH/SA) services for the majority of Medica members. UBH contracts with a network of behavioral health clinicians, programs and facilities to serve the behavioral health needs of Medica members. UBH is branded as Medica Behavioral Health when serving Medica members. This branding was introduced January 1, 2008, to reduce confusion for Medica members when accessing behavioral health services.
This section includes detailed information on:
Medica Behavioral Health's goal is to offer Medica members the most effective behavioral health treatment in the least restrictive setting.
Learn what Medica Behavioral Health offers.
- Live and Work Well—Prevention, self assessment, education, self-management tools.
- Assistance in identification of and access to outpatient care, including open certification to access the UBH network of outpatient clinicians.
- Authorization for more intensive outpatient services provides opportunity to evaluate complexity of clinical presentation and opportunity to apply additional resources.
- Coordination of inpatient and residential services to ensure appropriate level of care and to facilitate outpatient step down and follow up care.
- High risk follow-up program to support successful transition to the community and reduce risk of re-hospitalization.
- Health Advantage by Medica—Psychosocial support, education and self management tools, especially for members with co-occurring medical and behavioral conditions.
Medica members have the highest level of benefit for MH/SA services when they use the UBH provider network. Medica Behavioral Health representatives are available to assist in locating network providers. In addition, lists of network providers are available through:
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Twenty-four hour emergency care is available from the United Behavioral Health network. Medica Behavioral Health staff are available 24/7. Calls are assessed for urgency, and appropriate arrangements are made for face-to-face services. In situations where hospitalization may be needed, Medica Behavioral Health should be called immediately.
Most Medica members have outpatient and inpatient mental health/substance abuse benefits, which vary according to the member's benefit document. To obtain benefit information, members and particpating providers may call Medica Behavioral Health at Medica Behavioral Health representatives are also available to assist members and providers with general information, questions about behavioral health services, benefit interpretation, and resolution of problems and complaints.
Medica Behavioral Health contact numbers:
- For emergency care assistance or benefit information, call (800) 848-8327.
- For claims information, call (866) 214-6829.
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Medica recognizes that many patients seek care for behavioral health conditions from physicians other than psychiatrists. Medica contracts generally allow those physicians to bill
E&M and Behavioral Health CPT codes. A Medica Behavioral Health Psychiatrist is available during office hours for consultation with physcians on any of their patients. Questions regarding issues, such as patient evaluation, medication, alternatives, and referrals to other services can be addressed.
Call the Physician Consultant Line at (866) 799-1330.
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UBH contracts with psychiatrists, licensed psychologists, clinical social workers, clinical nurse specialists, substance abuse programs, residential and acute care mental health and substance abuse facilities.
UBH has a network of providers in the Medica Service Area to which membes will be referred to obtain MH/SA services. To locate a network provider:
Outpatient medication management services do not require prior authorization. Routine outpatient care requires an annual certification that allows a member to see any network provider. The member, a member representative or the network provider can obtain the certfication. Prior authorization is needed for all other, more intensive, behavioral health care. Prior authorization can be obtained by calling Medica Behavioral Health at (800) 848-8327. Generally, the provider gives Medica Behavioral Health clinical information in order to obtain authorization.
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Behavioral health services furnished by participating providers begin with an assessment by a mental health clinician. A treatment plan is developed through the assessment process. Ongoing therapy may be provided by the assessor, but in some cases, a referral may be made to a mental health clinician with expertise in a special area of treatment.
Behavioral health services include:
- Individual, family and group therapy.
- Psychiatric evaluation and medication management.
- Hospitalization when medically necessary.
- Attention deficit disorder diagnostic evaluations and testing.
Substance abuse services furnished by participating providers include:
- Assessment.
- Individual treatment planning.
- Outpatient and residential substance abuse programs.
In addition, Medical Behavioral Health provides referrals for multicultural and women's groups, and programs for DWI offenders.
Methadone or Cyclazocine treatment (or its equivalent) is available for State and Public Programs, including Medica Choice Care, MinnesotaCare, DUAL Solution and Accessibility Solution. Many commercial plans but not all, also offer this benefit.
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To obtain MH/SA services, a member may identify a network clinician online at Find a Doctor or at the Live and Work Well Web site. For an initial assessment to determine behavioral health needs and for routine mental health care, (outpatient mental health individual, group or family therapy) the member can schedule directly with a network clinician. Either the member or the clinician can obtain certification by contacting Medica Behavioral Health. The member may also choose to call Medica Behavioral Health at (800) 848-8327 for assistance in finding a network clinician or understanding their benefits.
For substance abuse services and more intensive services such as mental health day treatment, prior authroization is required. The member or network program contacts Medica Behavioral Health to obtain prior authorization.
Medica Behavioral Health expects that members will be able to access behavioral health services within the following timelines:
- Emergency services are available immediately.
- Urgent services are available within 24 hours.
- Routine services are available within 10 working days.
Call the Medica Behavioral Health Intake Number at (800) 848-8327.
Inpatient psychiatric consultations for members in a medical/surgical bed may be provided by network psychiatrists without prior authorization.
To access In-network benefits for inpatient behavioral health admissions, prior authorization is required. The in-network facility assesses the need and contacts Medica Behavioral Health to obtain authorization.
Out-of-network benefit admissions typically require authorization, depending on the certificate of coverage. Information on benefit levels and authorization requirements can be obtained by calling Medica Behavioral Health at (800) 848-8327.
Medica Behavioral Health must be notified of emergency admissions as soon as it is reasonable possible after the confinement begins by calling (800) 848-8327.
Authorization of the admission will be determined according to medical necessity. A member confined to a non-UBH hospital who wishes to sue the highest level of benefits may be transferred to a UBH participating hospital as clinically appropriate. Medica Behavioral Health will provide transportation arrangements to the most appropriate participating hospital when determined medically necessary.
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