Behavioral health services include mental health and substance use disorder treatment services. These services can help you with personal problems that may affect you and your family such as stress, depression, anxiety or using drugs or alcohol. Behavioral health services are covered at no cost to you. You must go to a behavioral health provider in UnitedHealthcare Community Plan’s network.

How to access behavioral health services

You have the right to choose a qualified behavioral health services provider.  You can find a list of in-network behavioral health providers [here].  You do not need a referral from our you Primary Care Provider (PCP) see behavioral health specialists in your plan or to access substance use disorder treatment services.

Your Primary Care Provider (PCP) and UnitedHealthcare Community Plan can also help coordinate your behavioral health care. You can find the name of your PCP on the back of your UnitedHealthcare Community Plan member ID card.

If you need help finding a behavioral health provider or getting the behavioral health care you need, please call Member Services at 1-877-542-8997, TTY 711, Monday – Friday, 8 a.m. – 5 p.m. (PT).

Go to Live and Work Well to get support and information for stress, mental health, substance use and  more.

Mental health services may include:

• Intake evaluation, assessment, and screening
• Peer support
• Mental health treatment interventions such as:
  • Individual, family and group therapy
  • Outpatient, residential and inpatient care
  • Intensive and brief treatment models
• Crisis Services
• Medication management and monitoring
• Care coordination and community integration
• Wraparound with Intensive Services (WISe)

Substance Use Disorder (SUD) treatment services may include:

• Assessment
• Brief intervention and referral to treatment
• Individual, family, and group therapy
• Outpatient, residential and inpatient
• Opiate substitution treatment services
• Case management
• Peer support
• Crisis services
• Withdrawal management (detoxification)

Wraparound with Intensive Services (WISe)

WISe is an approach to helping young adults ages 19 and 20 with intensive mental health care needs. The program takes a team approach designed to support young adults and families in meeting their individualized goals. You can find more information on the Washington Health Care Authority WISe webpage .

Applied Behavioral Analysis (ABA) 

ABA services assist individuals with autism spectrum disorders and other developmental disabilities in improving their communication, social and behavioral skills. To access ABA services and care coordination, call our ABA Support Line at 1-866-456-5376. 

Behavioral Health Advocates

A Behavioral Health Advocate (formerly called Ombuds) is a person who provides free and confidential assistance with resolving concerns related to your behavioral health services. They can also help if you have a behavioral health grievance, appeal, or fair hearing. Behavioral Health Advocates are independent of UnitedHealthcare Community Plan. They have also experienced behavioral health services themselves, or someone in their family member has had behavioral health services. 

You can find the phone number of the Behavioral Health Advocate in your county here.  Or you can contact the Office of Behavioral Health Advocacy at 1-800-366-3103 or email info@obhadvocacy.org.

Helplines

• Substance Use Disorder Helpline: Available 24 hours a day / 7 days a week.
  • Call: 1-855-780-5955
  • Online: liveandworkwell.com/recovery
• Washington Recovery Helpline: Crisis intervention and referral line for those struggling with issues related to mental health, substance abuse, and problem gambling. Available 24 hours a day/7 days a week.
  
  • Call or text: 1-866-789-1511 (TTY 206-461-3219)
  • Email:  recovery@crisisclinic.org 
  • 8:52 Online: warecoveryhelpline.org  
• Teen Link: Teens can connect with teens during specific hours.
  
  • Call: 1-866-833-6546
  • Email: teenlink@crisisclinic.org
  • Online: teenlink.org
• National Alliance on Mental Illness: Offers resources and support groups in Washington. 
  
  • Online: namiwa.org

Crisis services

A mental health crisis is when someone’s behavior can put themselves or others in danger, especially if they do not get help right away.

• For a life-threatening emergency, call 911.
• For a mental health crisis, call or text 988 (National Suicide Prevention Lifeline).
• For a mental health crisis or substance use disorder crisis that is not life-threating, call the Behavioral Health Administrative Services Organization (BH-ASO) in your county. The phone numbers can be found here and on the back of your UnitedHealthcare Community Plan member ID card.

Get the assistance you and your family need to stay healthy, to get better if you are injured or sick. Medical care services are covered at no cost to you. Some services require pre-approval.

Covered services include but are not limited to: 

• Primary care visits, wellness exams and immunizations
• Specialist visits
• Prescriptions
• Emergency and urgent care
• Hospital services
• Lab tests and X-rays
• Diabetes supplies
• Family planning
• Medical supplies and equipment
• Hearing/vision services and exams
• Transhealth services - hormone therapy and behavioral health support
• Quit smoking program

We use a list of approved prescription drugs called the Apple Health Preferred Drug List (PDL). The PDL is created by the Washington Health Care Authority. There is no cost to you for covered prescription drugs. Some prescription drugs require pre-approval.

In most cases, you need to try generic drugs first. Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration. 

You must use a pharmacy in our pharmacy network.   Some prescription drugs can be delivered to you in the mail.

Routine and preventive health care services for women, including family planning.

Covered services include, but are not limited to:  

• Mammograms
• Cervical cancer screening
• Reproductive health
• Birth control such as:
• FDA approved contraceptive drugs, devices and supplies, long-acting reversible contraceptives
• Over the Counter (OTC) FDA approved contraceptives
• Sexually transmitted disease testing and treatment
• HIV and AIDS testing
• Sterilization procedures

Pregnant individuals are not eligible for Apple Health Expansion. Pregnant individuals should enroll in the Apple Health for Pregnant Individuals which covers pregnant individuals regardless of immigration status. Go to Washington Healthplanfinder to enroll at wahealthplanfinder.org or call 1-855-923-4633, TTY 1-855-627-9604. 

Dental care is covered by Washington Health Care Authority (HCA) Apple Health Fee-for-Service. 

• To learn more about covered dental services, go to: hca.wa.gov/dental-services, or call HCA at 1-800-562-3022.
• To find a provider that accepts Washington Apple Health, go to: DentistLink.org, or https://fortress.wa.gov/hca/p1findaprovider/

Washington Health Care Authority Apple Health Fee-for-Service pays for transportation services to and from needed non-emergency health care appointments. 

Call the transportation provider (broker) in your area to learn about services and limitations. Your regional broker will arrange the most appropriate, least costly transportation for you. A list of brokers can be found at hca.wa.gov/transportation-help.

When possible, contact the transportation broker at least 7-14 days before of your health care appointment.

Vision coverage helps protect the health of eyes and prevents common eye diseases that may cause vision loss.

Covered services include: 

• Ophthalmology and optometrist exams
• Eye exams are not limited as long as it is for a medical condition
• Vision therapy
• Fitting fees for eyeglass and contact lens for vision-related hardware coverage, routine and medical

Ages 19 & 20: Eyeglasses and contact lenses are covered by Washington Health Care Authority Apple Health Fee-for-Service. You can find eyewear suppliers at: https://fortress.wa.gov/hca/p1findaprovider/.

Age 21 and older: Eyeglasses and contact lenses are not covered. For adults in need of eyeglasses at a reduced cost you can purchase eyeglass frames and lenses through participating optical providers. Find a list of participating providers at: hca.wa.gov/assets/free-or-low-cost/optical_providers_adult_medicaid.pdf. 

As a member of UnitedHealthcare Community Plan, you get access to value-added benefits. These extra benefits are no cost to you. They are offered in addition to the required Apple Health Expansion benefits and services.

• Healthy rewards: Earn rewards for completing important preventive care visits including immunizations, breast cancer screening, diabetes monitoring and more. Up to $200 per member per year. Eligible members will be notified by mail or email.
• Healthy lifestyles: AbleTo self-care app with emotional health tools including meditations, breathing exercises, videos, blogs and more. For more information, visit ableto.com/begin and follow the online steps to sign up (note: use your UnitedHealthcare member ID number as your access code.
• Transition support for jail/detention: Members transitioning out of jail/detention may receive duffel bags containing essentials upon leaving an incarcerated setting in addition to care coordination services. Member Services can refer incarcerated members to their assigned case manager. Call 1-877-542-8997, TTY 711

See more benefits and features

You will have a primary care physician (PCP) who will be your main doctor. The name of your PCP is on the front of your UHC Member ID Card. Your PCP is the person you should see for most of your care. This includes checkups, treatments, vaccinations, minor injuries and health concerns. 

Talk to your PCP about any behavioral health concerns you may have.  Your PCP can help you decide the right options for you.

Your PCP is your main doctor for:

• Preventive care
• Treatment if you are sick or injured
• Referrals to specialists for certain conditions

Go to 'Find a Medical provider' or 'Find a Behavioral health provider'  to see if your doctor is in our network. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

Case management helps members with multiple health care needs get care. A case manager can help coordinate care with your doctor. 

Case management includes but is not limited to:

• Care plans
• Community resources
• Transgender health services
• Coordination and referral to Applied Behavioral Analysis (ABA) services

Diabetes is a condition that happens when your blood sugar (glucose) is too high.

Covered services include but are not limited to:

• Prescription drugs
• Supplies 
• Diabetes education
• Healthy Rewards for diabetes monitoring

Diagnostic tests, radiology, and labs help doctors decide what might be wrong with a person's body. 

Covered services include but are not limited to:

• Cardiology and radiology (imaging studies)
• X-rays
• Lab visits
• Genetic testing 

Call 911 or go to the nearest emergency room if you have a sudden or severe health problem that you think is an emergency. Only go to the hospital emergency room if it’s an emergency. Do not go to the emergency room for routine care.

Call us as soon as possible afterwards to let us know that you had an emergency and where you received care. You do not need pre-approval to get care in an emergency. You may use any hospital or emergency setting in the United States if you are having an emergency.

Hearing services and equipment to help you hear better.

Covered services include: 

For ages 19 and older:

• Routine hearing exams
• Testing and therapy
• Monaural and binaural hearing aids, including fitting, follow-up care, batteries, and repair
• Bilateral Cochlear Implants, including implants, parts, accessories, batteries, chargers, and repairs

For age 19 & 20:

• Services list above; and
• Bone-Anchored Hearing Aids (BAHA), including BAHA devices (both surgically implanted and soft band headbands), including BAHA replacement parts and batteries

Kidney disease is when your kidneys are damaged and cannot filter your blood the way they should.

Covered service include but are not limited to:

• Dialysis
• Medications
• Health education and support
• Organ transplant, if needed

Hospitalization is when you stay overnight for inpatient services and care at a hospital. 

Inpatient services and care must be pre-approved by us (unless it is for emergency care). After you leave the hospital, we will help you with follow-up care to continue healing at home.

Routine immunization and vaccines help protect you from illness. You can get immunizations and vaccines at your PCP, pharmacy or local health department.

Covered services include but are not limited to:

• Recommended immunizations and vaccines
• Influenza shots

For more information, go to doh.wa.gov/youandyourfamily/immunization.

Medical equipment and supplies are covered when medically necessary and prescribed by your health care provider. We must pre-approve most medical equipment and supplies before we will pay for them. 

Covered equipment and supplies include but are not limited to:

• Incontinence supplies
• Blood monitoring and testing supplies
• Continuous positive airway pressure machine (CPAP)
• Hospital beds
• Oxygen equipment and supplies 
• Wheelchairs or walkers

Pregnant individuals are not eligible for Apple Health Expansion. Pregnant individuals should enroll in the Apple Health for Pregnant Individuals which provides coverage regardless of immigration status.

Go to Washington Healthplanfinder to enroll at wahealthplanfinder.org or call 1-855-923-4633, TTY 1-855-627-9604. 

Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. 

Covered services include but are not limited to: 

• Annual wellness exams and screenings
• Routine shots and tests

Tobacco and smoking cessation services helps people quit using all forms of tobacco, including vaping, smoking and chewing tobacco. It helps you learn skills to overcome cravings and improve your health.

Covered services include:  

• Personal, one-on-one coaching support
• Free 8-week supply of nicotine replacement therapy (patch or gum)
• Bupropion/Chantix decision support (prescription required)

To enroll or for more information, call 1.866.Quit.4.LIFE (866-784-8454) TTY (877-777-6534) or go online: www.myquitforlife.com/uhcwa.

A Skilled Nursing Facility (SNF) is an inpatient facility that provides rehabilitation and medical treatment. It helps person to recover from surgery or illness before going home.

Care at a Skilled Nursing Facility is covered when it is decided that the nursing facility care is the right place for care instead of a hospital. Pre-approval is required.

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Covered services include but are not limited to:

• Occupational therapy
• Physical therapy
• Speech therapy
• Cardiac rehabilitation

Service related to transhealth and the treatment of gender dysphoria. 

Covered services include but are not limited to:

• Physician services
• Hormone therapy
• Puberty suppression therapy
• Behavioral health services

Contact Member Services at 1-877-542-8997, TTY 711.

Gender reassignment surgery is covered by Washington Health care Authority Fee-for-Service). To learn more go to:  http://www.hca.wa.gov/transhealth, or email: transhealth@hca.wa.gov