Understanding the interaction between mental health and medical health improves results.
If you are a provider in Clark or Skamania County, please call customer service: 1 (866) 418-1009 or refer to the provider manual.
If you are a mental-health provider, there may be times when you need to refer a member to a Behavioral Health Organization (BHO) for further evaluation and treatment under one of two conditions:
1. The member’s symptoms have worsened, and it is likely that they now meet the BHO’s access to care standard
2. You are working with an Apple Health member––an adult or a child––who is about to exhaust their outpatient mental-health benefit for the year and may qualify for continued care.
Referring for Mental Health Care
Occasionally a physician will provide medical care to an enrollee who has untreated or under-treated mental-health needs. This will typically include problems with mood or anxiety disorders, though a member may also just need some help getting through a difficult time in their lives. In many of these cases, a referral to a mental-health provider is in order.
Members who are referred for mental-health treatment need to be initially evaluated in order to determine the severity of their symptoms using the Access to Care Standards, according to our contract with the state. Those members who meet the standards need to be referred to the BHO for further evaluation and possible treatment.
If you aren’t sure whether or not your patient’s mental-health symptoms meet the Access to Care Standards, you can refer them to the BHO in your area for an initial workup. The BHO will inform you if the member does or doesn’t meet the standards. From that point, a referral can be made to an appropriate provider in the community.
If you know that your patient does not meet the standards, you are welcome to refer them to the mental-health provider of your choosing. If you need help finding a mental-health provider, Community Health Plan of Washington maintains a helpful list of contracted providers. You can also visit the links below for more information:
- How to get help with mental health services from the Behavioral Health Organization near you.
- Contact information and a listing of substance abuse treatment services.
- How to get help with substance abuse treatment in Washington state.
Referring for Chemical Dependency Treatment
Some patients seeking medical care have ongoing problems with alcohol or drug abuse, and although drug abuse is a treatable condition in its own right, it often complicates even routine health care. For that reason, pre-assessing problems with substance abuse is an increasingly important service primary care physicians and other medical care providers can carry out.
If you suspect––or have determined––that a patient has an alcohol or drug problem, please make a referral to a qualified treatment provider or treatment facility. Community Health Plan of Washington maintains a network of contracted chemical dependency providers whose contact information is included in our Provider Directory.