Navigating mental health care Coverage plans can be overwhelming, particularly due to the financial challenges often involved. Even a few therapy sessions can have a big impact on your budget if you don’t have an insurance plan to help cover the cost. Fortunately, Gold Coast Health Plan (GCHP) is committed to offering its members essential mental health services through a variety of coverage options.
This guide will explore everything you need to know about Gold Coast Health Plan, focusing on its mental health and therapy coverage. We will outline the healthcare services included in your plan and provide tips on utilizing your benefits effectively.
Key takeaways
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Gold Coast Health Plan (GCHP) is a managed care organization offering Medi-Cal coverage to Ventura County, California residents.
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GCHP covers in-person and online therapy, including services like cognitive behavioral therapy (CBT), family therapy, and medication monitoring.
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It includes outpatient mental health, emergency follow-ups, and substance use disorder treatments through Carelon Behavioral Health.
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Members can use the GCHP provider directory, contact customer service, or access services via platforms like Grow Therapy for mental health support.
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Certain therapies like hypnotherapy or non-traditional treatments are not covered.
What is Gold Coast Health Plan insurance?
Gold Coast Health Plan (GCHP) is a managed care organization providing Medi-Cal coverage to people living in Ventura County, California. The cities in Ventura County include:
- Oxnard
- Camarillo
- Ventura
- Simi Valley
- Thousand Oaks
- Santa Paula
- Moorpark
- Fillmore
- Port Hueneme
- Ojai
Operating under the California Department of Health Care Services (DHCS), the plan ensures members receive comprehensive healthcare that meets state Medi-Cal standards and regulations.
Gold Coast Health Plan partners with Carelon Behavioral Health for mental health services. This partnership gives GCHP members access to a wide network of mental health providers. Carelon Behavioral Health focuses on both mental health and substance use disorders.
Which states is Gold Coast Health Plan available in?
GCHP serves Ventura County, California residents under the Medi-Cal program. It provides a variety of health benefits, including comprehensive mental health services.
Members can access a wide network of in-person and online therapists within the state, ensuring coverage for a broad array of mental health needs, from anxiety and depression to more complex behavioral issues.
Does Gold Coast Health Plan cover therapy?
Yes, GCHP typically covers both in-person and online therapy sessions. This includes a wide range of mental health services designed to assist with various issues such as substance abuse, depression, anxiety, stress, relationship challenges, and obsessive-compulsive disorder (OCD). Whether you prefer traditional face-to-face sessions or online therapy’s convenience, your plan will likely accommodate your needs.
What therapy does Gold Coast Health Plan cover?
GCHP coveres a wide array of mental health services:
- Mental health assessments: GCHP covers initial assessments at no cost for people who think they could benefit from mental health treatment. You don’t need a referral and can be assessed by any licensed mental health provider in the Carelon Behavioral Health Network.
- Outpatient mental health: GCHP covers outpatient mental health services for people of all ages, including individual and group therapy, substance use disorder treatment, psychological testing, and medication monitoring.
- Emergency Department (ED) visits: GCHP will follow up with members after an ED visit to make a plan for ongoing behavioral health support.
- Specialty mental health services (SMHS): If you require more intensive treatment, your primary care physician (PCP) or mental health care provider can refer you for services such as crisis intervention services, psychiatric inpatient services, and more.
- Substance use disorder services: Members struggling with drug or alcohol use can call 844.385.9200 to learn about their options.
While it’s important to confirm the specifics of your plan, here are some common therapies that may be included:
In addition to these standard therapies, GCHP may also cover more specialized treatments depending on your diagnosis and previous therapies.
These can include:
- Individual and group mental health evaluation and treatment
- Psychological testing to assess your mental health condition
- Development of skills to improve attention, memory, and problem-solving
- Outpatient services to monitor medication therapy
- Outpatient lab, medicines, supplies, and supplements
- Psychiatric consultation
Also, the plan covers services provided by various licensed professionals, such as:
- Licensed Marriage and Family Therapists (LMFT)
- Licensed Clinical Social Workers (LCSW)
- Psychiatrists
- Psychologists
- Certified Alcohol and Substance Abuse Counselors
Be sure to double-check your specific plan or reach out to GCHP directly to understand what therapy may be covered by your insurance.
Search for therapists who accept Gold Coast Health Plan
Medication coverage with Gold Coast Health Plan
GCHP provides comprehensive medication coverage for its members through the Medi-Cal Rx program. Here’s an overview of the key aspects of medication coverage under GCHP:
Medication coverage overview:
- Prescription medications: GCHP covers a wide range of prescription medications that are determined to be medically necessary. Members can access these medications through a network of pharmacies managed by OptumRx, the plan’s Pharmacy Benefits Manager (PBM).
- Over-the-counter medications: Certain over-the-counter medications may also be covered if a physician or mental health clinician prescribes them.
Important Considerations:
- Some medications may require prior authorization based on factors such as age, dosage, and maximum quantities.
- Brand-name medications will not be covered if a generic alternative is available without prior authorization. Members are encouraged to choose generic options to reduce costs.
- Members can use mail-order services, allowing them to conveniently receive a 90-day supply of their medications.
- Members must present their benefits ID card at the pharmacy when obtaining medications. Pharmacies can contact Medi-Cal Rx for assistance if there are any billing issues.
For the most accurate information, consult your Member Handbook or contact GCHP Member Services.
What types of therapy does Gold Coast Health Plan not cover?
GCHP covers many types of therapy that may help you with your mental health needs. However, some types of mental health services are not covered by the GCHP.
Examples of these services include:
- Hypnotherapy: Hypnotherapy uses hypnosis to help people with their mental health problems. Although some people find it helpful, GCHP does not believe it is a reliable or effective treatment for mental health issues.
- Non-traditional therapy: Non-traditional therapy, such as biofeedback therapy, aims to help people control their body’s response to stress and anxiety by giving them feedback about their body’s functions, like their heart rate or blood pressure. GCHP does not cover this type of therapy because they do not think there is enough evidence to prove it’s an effective treatment.
Any therapy or service not shown to be medically necessary is not covered. This includes treatments that do not meet established clinical guidelines.
Does Gold Coast Health Plan cover online therapy?
GCHP covers online therapy, often called telehealth or virtual therapy, and in-person therapy. This flexibility allows members to access mental health care from the comfort of their homes while still receiving quality support from licensed professionals.
Telehealth services are particularly beneficial for those with difficulty attending in-person sessions. This may be due to transportation issues, time constraints, or health concerns. Members can engage in various therapeutic treatment types online, including cognitive behavioral therapy (CBT), family therapy, and group therapy.
GCHP partners with providers like Grow Therapy to help with these online sessions. This ensures members can access a network of qualified therapists across multiple states.
To find out if telehealth services are available in your area or to locate a therapist who offers online sessions, it’s a good idea to check the GCHP provider directory or reach out to Grow Therapy for a list of local providers. This way, you can make the most of your mental health coverage with convenient options.
Does Gold Coast Health Plan cover out-of-network therapy?
GCHP generally does not cover out-of-network therapists. If you consider seeing an out-of-network provider, you may see higher costs than in-network services. In most cases, you may need to pay out-of-pocket for these services and then file for reimbursement with GCHP. This process can be more complicated and may result in higher overall expenses since out-of-network providers usually do not have negotiated rates with the insurance company.
If you have questions or need further clarification, contacting GCHP can provide you with the most accurate and detailed information regarding your options.
How to check if your Gold Coast Health Plan covers therapy
There are two main ways to find out if your Gold Coast Health Plan plan covers therapy and, if so, what it covers and how much it will cost.
1. Check your Gold Coast Health Plan Summary of Benefits
To understand your out-of-network coverage specifics, it’s crucial to refer to your summary of benefits (SOB). The SOB will outline what is covered under your plan, including any limitations or exclusions related to out-of-network care.
Example Only
If the “Network Provider” and/or “Out-of-Network Provider” give cost information, such as a copay or coinsurance, then your Gold Coast Health Plan plan does cover mental health services.
If the “Network Provider” and/or “Out-of-Network Provider” say “not covered,” then your Gold Coast Health Plan plan does not cover mental health services such as therapy.
To learn more about how the summary of benefits are structured, refer to this sample SOB from the Centers for Medicare & Medicaid Services website.
2. Contact Gold Coast Health Plan Directly
Contacting Gold Coast Health Plan directly is the best way to get the exact information you need about what types of mental health care are covered.
To find contact information for Gold Coast Health Plan, you can:
- Call the Member Services Department at 888.301.1228 (8am to 5pm M-F)
- Use the Gold Coast Health Plan website to log into your account, and either chat or email a Gold Coast Health Plan representative directly
Gold Coast Health Plan therapy copay
When paying for therapy, your copay (or copayment) is an important cost you should know about.
The copay is a fixed amount you have to pay for each therapy session. Copays can vary depending on your plan, as well as the therapist you see, so it’s important to double-check your copay under the mental health coverage section on your summary of benefits.
If you have any doubts or questions about if you have to pay a copay, or what your copay is, you should reach out to Gold Coast Health Plan support directly.
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Does Gold Coast Health Plan require a referral to see a therapist?
For most mental health services through GCHP, you don’t need a referral from your primary care provider (PCP). However, remember that some specialized services might require prior authorization to be covered.
If you are assigned to a PCP, you must have a referral to see another doctor. Your PCP can directly refer to any other GCHP provider in the county network without authorization from GCHP.
To learn more, visit the Gold Coast Health Plan website.
How to find a therapist covered by Gold Coast Health Plan
Finding the right therapist is an important step in your mental health journey. GCHP makes this process manageable. Here are several ways to find a provider who meets your needs:
1. Gold Coast Health Plan directory of therapists
GCHP offers an online provider portal for searching for a mental health professional. It is easy to navigate for both established patients and new patients.
GCHP’s online directory can save you time and effort in finding a mental health provider. Instead of calling multiple providers to see if they accept your insurance, you can quickly and easily find in-network providers in your area with just a few clicks.
The easiest way to start your search is through GCHP’s online provider directory. Visit the GCHP website and use the “Find a Provider” tool. You can filter your search by:
- Type of provider (therapist, psychiatrist, etc.)
- Location within Ventura County
- Languages spoken
- Gender preference
- Specializations
Call 1-805.437.5961 if you need language assistance.
2. Contact Gold Coast Health Plan customer service
Sometimes, speaking with someone directly can help you find the best match for your needs. You can contact Carelon Behavioral Health member services by calling the number on the back of your member ID card. Their specialized team can:
- Help determine what type of provider might be best for your situation.
- Search their network for providers who match your preferences.
- Assist with scheduling appointments.
- Answer questions about your coverage.
3. Talk to your primary care provider
While you don’t need a referral, your PCP can be a valuable resource in finding mental health care. They often have working relationships with mental health providers in the area and can suggest providers who might be a good fit for your specific needs.
4. Use a therapy provider like Grow Therapy
With Grow Therapy, you can search for mental health providers who are in-network with Gold Coast Health Plan for both in-person and online therapy. You can browse the growing network of vetted therapists and use filters to search by age, specialty, gender, and more. Simply pick the therapist who meets your unique needs and book your first session.
You’ll be asked to enter your insurance information to verify eligibility and receive a cost estimate when booking.
What do terms like deductible, copays, and coinsurance mean?
Navigating the insurance system—especially when you’re in need of mental health support—can be challenging and confusing. For help, please visit our understanding health insurance article.
Navigating common issues with Gold Coast Health Plan health coverage
Even with comprehensive coverage, you might encounter some challenges. Some common reasons that a claim might be denied include:
- Lack of prior authorization
- Service not covered
- Incorrect coding or billing
- Exceeding plan limits
- Out-of-network provider
- Missing or incomplete information
- Failure to meet medical necessity criteria
- Duplicate claims
If your claim Is denied
If you receive a denial, there may still be ways to get your care covered. Here’s what to do:
- Review the denial notice carefully to understand the specific reason.
- Gather supporting documentation from your healthcare provider.
- Contact Gold Coast Health Plan Member Services at 1.888.301.1228 to discuss your options.
- File an appeal within 60 days if you disagree with the decision.
- Consider requesting a state fair hearing if your appeal is denied.
When you need prior authorization
Some services require approval before you can begin treatment. Here’s how to handle this:
- Work with your provider to submit the necessary documentation.
- Follow up within five business days if you haven’t heard back.
- Ask about alternative options if authorization is denied.
- Contact Carelon Behavioral Health for help navigating the process.
Making the most of your mental health coverage with Gold Coast Health Plan
Taking an active role in your mental health is essential. Gold Coast Health Plan provides valuable mental health services designed to support your well-being. By understanding your coverage and knowing which services are available, you can make the most of your mental health benefits.
Whether you need therapy, support for substance use, or counseling, taking the time to explore your options and find the right provider can make a significant difference in your mental health journey.
Regularly reviewing your plan ensures that you stay informed about any changes to your mental health benefits. This proactive approach can help you avoid unexpected costs and gaps in care when you need it the most.