Behavioral Health
Behavioral health benefits and Emotional Wellbeing Solutions are administered by Optum®. Visit the Emotional Wellbeing Solutions webpage for more information.
Optum
855.HERE4TN (855.437.3486)
24/7
Here4TN.com
Eligibility
Members and dependents enrolled in medical insurance have behavioral health benefits available through Optum, your behavioral health vendor. All health plans include access to outpatient and facility-based behavioral health and substance use disorder services.
First Call Provider Search
The Here4TN team will find you a provider based on your specific preferences, concerns and availability.
Call 855.437.3486 or visit Here4TN.com for more benefits information and resources.
ID Cards
Can’t find your Optum ID card? You can call to request a new one.
The goal with Optum ID cards is to reduce or remove confusion about where claims or questions about behavioral health benefits should go. Members should present this ID card to their mental health professional when seeking care.
Services
Whether you’re dealing with a mental health or substance use condition, support is available for members and eligible dependents through your behavioral health coverage.
For a full list of behavioral health services, click here.
Behavioral health assistance (855.HERE4TN) includes, but is not limited to:
· Helping you find a network provider or facility
· Helping you schedule an appointment
· Explaining your benefits
· Identifying the best treatment options
· Helping you obtain a prior authorization
· Answering your questions
Network Provider: To receive maximum benefit coverage, participants must use a network provider. To find a network provider, call 855-Here4TN. Optum can help you schedule your appointments when you call. Preauthorization is required for non-routine outpatient and all facility-based services. A provider directory with a search feature is available at Here4TN.com.
Participants may see an out-of-network mental health provider without calling for a referral, but coinsurance and copayments will be higher. Participants are also subject to balance billing by the out-of-network provider. This means participants will pay the difference between the maximum allowable charge and the actual charge. In addition, participants are at risk of having inpatient and facility-based benefits denied. Certain services are excluded under the terms and conditions of the State Group Insurance Program.
Click here for Substance Use Waived Treatment Costs Information.
Virtual Visits, available in addition to in-person office visits, let you meet with a provider through private, secure video conferencing. They allow you to get the care you need sooner and in the privacy of your home.
Virtual visit copays are the same as an office visit. To get started, go to Here4TN.com, scroll down, select provider search and filter results by virtual visits to find a provider licensed in Tennessee. You may also call 855-Here4TN for assistance.
Click here for additional Behavioral Telehealth Information.
Applied Behavior Analysis therapy: ABA helps teach children with autism numerous life skills and behaviors they may otherwise not learn on their own. Your health plan has an expanded ABA benefit. With Autism Spectrum Disorder, it’s never too soon to learn about services that can help you, your child and whole family live happier and healthier lives.
Family Support Program: The Family Support Program provides the ease and accessibility of a single point of contact for caregivers of children with behavioral health concerns including autism, anxiety, depression and other issues. The program is designed to help families navigate the often-confusing tangle of resources and stakeholders that can include schools, providers, public agencies and more.
Services and Resources
- Online resources can be accessed via Here4TN.com
- More than 5,000 articles, videos, podcasts, webinars and newsletters
- Self-assessments and personal plans
If you disagree with a decision or the way a claim has been paid or processed, you or your authorized representative should first call member service at Optum: 855-Here4TN (855.437.3486) to discuss the issue.
First Level Appeal — If the issue cannot be resolved through member service, the member or his/her authorized representative may file a formal request for internal review or member grievance by contacting Optum. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgment letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of their case from an independent review organization.
Second Level Appeal — If the member's first level appeal is denied, the member or his/her authorized representative may file a second formal request for internal review or member grievance by contacting Optum. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgment letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of the case from an independent review organization.
External Review — If the member's first and/or second level internal appeal is denied due to medical necessity, the member or his/her authorized representative may choose to request that an independent review organization review the case and make a final determination. The independent review organization will report their decision to the member. This decision will be final and binding on the member, the plan and the carrier.
The appeals/grievance form can be initiated by contacting Optum. Members will have 180 days to initiate an internal appeal following notice of an adverse determination. Notification of decisions will be made within the following time frames, and all decision notices shall advise of any further appeal options:
- No later than 72 hours after receipt of the claim for urgent care
- 30 days for denials of non-urgent care not yet received
- 60 days for denials of services already received