BEHAVIORAL
Health Plan through Carolina Behavioral Health Alliance Snapshot Confidential assessment and service for mental health and substance abuse issues Provider Carolina Behavioral Health Alliance (CBHA) (800) 475-7900 cbhallc.com
ELIGIBILITY: Must be enrolled in the medical plan. If you have elected Wake Forest University medical coverage, you are automatically enrolled in a behavioral health plan at no additional cost. MENTAL HEALTH AND SUBSTANCE ABUSE Coverage for mental health and substance abuse services is coordinated through Carolina Behavioral Health Alliance (CBHA). Participants or covered family members seeking professional help or information on mental health or substance abuse issues may contact CBHA for a confidential assessment and service. A CBHA-licensed clinical case manager can direct them to an in-network provider and help ensure the most appropriate level of care is delivered timely, efficiently, and effectively. PRIOR AUTHORIZATION Inpatient treatment, partial hospitalization, and intensive outpatient programs require prior authorization by CBHA before receiving treatment. The participant or the treating provider may call CBHA for authorization. Outpatient services requiring prior authorization include: • Psychological testing • Electroconvulsive therapy • Home visits by a behavioral health provider
The behavioral health plan has a separate $1,000 out-of-pocket maximum for both in- and out-of-network providers. The out-of-pocket maximum includes office visit copayments and all coinsurance amounts associated with mental health and substance abuse services coordinated through CBHA. Additional online services include: • Provider search • Alcohol, opiates, and depression assessments • Information on support groups and other community resources • Informative articles ADAPTIVE BEHAVIORAL TREATMENT The behavioral health plan has been expanded to include coverage for Adaptive Behavioral Treatment (ABT). Members can access ABT services by calling CBHA at (800) 475-7900. A clinician will help determine the type of services needed, the diagnosis, treatment planning, or therapy, and will direct the member to an in-network provider who can assist with these services. Benefits payable under ABT services are limited to $40,000 per member per year.
SUMMARY OF COVERED SERVICES* FEATURE
LOW PLAN
HIGH PLAN
In-Network
Out-of-Network
In-Network
Out-of-Network
Inpatient Care
100% covered
60% covered
100% covered
70% covered
Outpatient Care
$25 copayment
60% covered
$25 copayment
70% covered
*The information above is intended as a benefit summary only. It does not include all of the benefit provisions, limitations, and qualifications. If this information conflicts in any way with the contract, the contract will prevail. Any services rendered under the CBHA benefit do not apply toward the BCBSNC annual deductible, coinsurance, or out-of-pocket maximum.
14 | Questions? Call (336) 758-4700 or email AskHR@wfu.edu