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Skip Navigation LinksHome » Health Benefit Info Active » Behavioral Health  
 

Behavioral Health and Substance Abuse
ComPsych Guidance Resources® (ComPsych) is the Plan’s network provider selected to help you obtain the care you need for behavioral health issues, substance disorders and other serious life problems.
 
 
A covered individual or family member may obtain prior authorization from ComPsych at 1-888-860-1566 for an authorization BEFORE seeking treatment for behavioral health or substance abuse even if you chose a provider that is not in the ComPsych network.  Keep in mind, the ComPsych network is different from your medical provider network which is with Blue Cross of Illinois.
 
Take advantage of the Member Assistance Program:  You have access to a Member Assistance Program (MAP) through ComPsych that provides confidential support, resources and information to get you through life’s challenges.  MAP services are confidential, free of charge to you and available 24 hours a day, 7 days a week.  Just call ComPsych at 1-888-860-1566 to speak to a ComPsych counselor about personal problems, such as job pressures, marital and family conflicts, problems with your children, relationship issues, grief and loss, elder care, stress, anxiety or depression, empty-nesting, eating disorders, major life changes, physical or emotional abuse, career transition, drug and alcohol abuse, legal issues, financial issues or planning, or simply managing daily life situations that can affect your work, health and family. 
 
The MAP offers free short-term counseling of up to five sessions (not subject to the Plan’s deductible or co-insurance) with a ComPsych counselor.  If a counselor determines that an issue cannot be addressed in the five, free counseling sessions or if a more intensive level of care is required, the counselor will work with you to locate a provider in the ComPsych network – provided the care is covered under the Plan’s behavioral health and substance abuse provisions. 
 

 

ComPsych In-Network Provider

Out-of-Network Provider

·     Member Assistance Program (MAP)

100% paid by Plan for 5 counseling sessions

No Coverage

 

If you lose eligibility for benefits after January 1, 2015, you will still have access to the Members Assistance Program for up to one year.
 
When you use a ComPsych hospital/provider you will receive a significantly higher level of benefits. This means a lot less money out of your pocket. The Plan pays as follows:

 

 

ComPsych In-Network Provider

Out-of-Network Provider

·     Emergency Room

o   Facility

o   Physician Fees

 

80% paid by Plan

80% paid by Plan

 

80% paid by Plan

80% paid by Plan

·     Emergency Room Co-Payment

$250 per Emergency Room Visit 

Waived if admitted to the hospital as an in-patient within 72 hours, or kept in Observation for more than 24 hours.

·     Hospital - In-Patient and Partial Hospitalization including Residential

80% paid by Plan

60% Paid by Plan

·     Hospital Confinement Maximum

180 days per Calendar Year for In-Patient and

Partial Hospitalization combined

·     Hospital Out-Patient Diagnostic Tests

80% paid by Plan

60% paid by Plan

·     Intensive Out-Patient and Out-Patient Treatments

80% paid by Plan

60% paid by Plan

·     Custodial or Group Homes

No Coverage

 
All hospital and professional benefits are subject to the calendar year deductibles and out-of-pocket maximums.  PPO in-network and non-PPO out-of-network deductibles and out-of-pocket maximums are separate and cannot be combined. The Plan does not pay for expenses above reasonable and customary allowance for non-PPO out-of-network providers.  Please see your Summary Plan Description for more information. 
 
Pre-Certification/Authorization – A ComPsych Care Manager will help you identify your options and develop a treatment plan that may include counseling, referrals to community resources or more intensive clinical treatment. The Care Manager will help you select a provider from the ComPsych network that specializes in your problem and is in a location convenient to you. Although you do not have to use a ComPsych network provider, benefits will be paid at a higher level if one is used. All claims for mental health and substance abuse benefits must be filed with ComPsych at:  P.O. Box 8379, Chicago, IL  60680-8379.
 
Concurrent Review - During your treatment, a ComPsych Care Manager will work with your provider and monitor the progress to make sure that the care received is appropriate and effective. Benefits will be paid only if your treatment is determined medically necessary by ComPsych.
 
Remember, to receive the highest level of benefits you or a family member should contact ComPsych at 1-888-860-1566 and use a provider in the ComPsych network.
 
 
 

 

 

 
 

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