Insurance

Gold Coast Health Plan mental health and therapy coverage: what you need to know

Navigating mental health care can feel overwhelming, but Gold Coast Health Plan makes it easier for Ventura County residents with comprehensive Medi-Cal mental health coverage. Explore your benefits and learn how to access affordable, high-quality mental health care.

Alyse Thompson, MD By Alyse Thompson
A white woman holds a large map in front of her face as she stands in front of a silver vehicle.

Published on Jan 27, 2025

Updated on Jan 27, 2025

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

  • Gold Coast Health Plan (GCHP) is a managed care organization offering Medi-Cal coverage to Ventura County, California residents.

  • GCHP covers in-person and online therapy, including services like cognitive behavioral therapy (CBT), family therapy, and medication monitoring.

  • It includes outpatient mental health, emergency follow-ups, and substance use disorder treatments through Carelon Behavioral Health.

  • Members can use the GCHP provider directory, contact customer service, or access services via platforms like Grow Therapy for mental health support.

  • 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:

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:

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:

Also, the plan covers services provided by various licensed professionals, such as:

Be sure to double-check your specific plan or reach out to GCHP directly to understand what therapy may be covered by your insurance.

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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:

Important Considerations:

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:

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.

Chart header.Example chart of what you will pay.

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:

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.

Chart header.

Example chart of what you will pay.

Sample image 

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:

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:

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.

Even with comprehensive coverage, you might encounter some challenges. Some common reasons that a claim might be denied include:

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:

  1. Review the denial notice carefully to understand the specific reason.
  2. Gather supporting documentation from your healthcare provider.
  3. Contact Gold Coast Health Plan Member Services at 1.888.301.1228 to discuss your options.
  4. File an appeal within 60 days if you disagree with the decision.
  5. 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:

  1. Work with your provider to submit the necessary documentation.
  2. Follow up within five business days if you haven’t heard back.
  3. Ask about alternative options if authorization is denied.
  4. 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.

Frequently asked questions
  • Grow Therapy connects clients, therapists, and insurance companies to make mental healthcare simple to access.

  • We make it easy to find a therapist who looks like you and can support your needs. The right therapist is one who ensures you feel safe and comfortable. If you need help choosing, read these tips or contact our scheduling team by phone at 786-244-7711. More contact options are available here.

  • We conduct an intensive interview process to ensure our therapists have the skills, training, and experience to help you grow.

  • People who use their insurance save an average of 78% on the cost of therapy. Sessions cost an average of $21 with insurance, but will vary depending on your plan. Get a cost estimate, learn more about how to check your coverage, or contact your insurance company for more details.

About the author
Alyse Thompson, MD Alyse Thompson

Alyse Thompson is a physician with over 15 years of comprehensive care experience. She has helped patients manage both physical and mental health concerns, including depression, stress, anxiety, eating disorders, and chronic illnesses.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

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