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Carelon Behavioral Health, Inc. (Carelon) provides this Provider Search to help you find behavioral health providers who participate in your health plan's network.

Provider participation may vary by health plan, network, location, and benefit. Make sure you select the health plan and network that apply to your coverage. Your member ID card or health plan documents can help you identify your network.

Some California health plans represented in this provider directory are regulated by the California Department of Managed Health Care (DMHC). The information in this notice is provided for members of those plans.

If you have any questions or concerns with this directory, you can contact Carelon Behavioral Health of California at 800-228-1286 or prsfeedback@carelon.com.

You may also contact the Help Center with the DMHC at 888-466-2219. For people with hearing or speech disabilities, please use the Telecommunications Device for the Deaf (TDD) line at 877-688-9891.

The Department's website, www.dmhc.ca.gov, has complaint forms, Independent Medical Review (IMR) application forms, and instructions online.

The information below applies to members using Carelon Behavioral Health Provider Search. Additional state- and plan-specific information is included later in this disclaimer. Members can call the toll-free number on their member ID card for help.

Provider Search and Network Information

Provider Search can help you find providers who participate in your health plan's network. A provider may participate in some Carelon networks or health plans but not others.

Some health plans may have network tiers or require a referral before you receive certain services. Your costs may also vary based on the provider, facility, network, or tier you use.

Carelon advises enrollees to contact providers or facilities before treatment to confirm they are in-network and they are covered under the enrollee’s specific health plan.

Check your health plan documents or call the Member Services number on your member ID card if you have questions about your network, benefits, covered services, referrals, costs, or provider participation.

For the most current information about appointment availability, contact the provider directly.

Provider Search shows whether a provider is accepting new patients based on the most recently confirmed information and applicable directory requirements. Because appointment availability can change, contact the provider for the most current information.

If you cannot find an available in-network provider, contact your health plan for help. Your health plan can help you find another provider and explain when you may be able to get covered care from an out-of-network provider.

Carelon network providers have agreed to charge members only for authorized member expenses, such as copayments, coinsurance, and deductibles, as outlined in the member's plan.

Providers are not allowed to require payment of concierge, facility, or other administrative fees as a condition for treatment.

If you have questions about a charge or your costs for care, contact your health plan using the Member Services number on your member ID card.

To report possible inaccurate, incomplete, or misleading provider directory information:

• Use the "Report Corrections" link shown with the provider's information;
• Email Carelon Behavioral Health at pnsfeedback@carelon.com; or
• Call 800-228-1286, TTY 800-735-2929, or the telephone number on your member ID card.

Carelon will review reported directory issues and update information when needed.

A provider or facility may leave your health plan's network. If this happens, your health plan may notify you and explain how the change may affect your care and costs.

If you relied on Provider Search information that you believe was incorrect or misleading, or if a provider's network status changed and you have questions about your costs, contact your health plan.

Your health plan can explain the protections that apply to you and whether you may be able to continue care with the provider.

A facility may be in your network, but some providers who work at that facility may not be in the same network.

Before getting non-emergency care at a facility, contact your health plan if you have questions about whether the providers who may treat you are in your network.

Some health plans cover certain services from out-of-network providers. Your costs for out-of-network care may be different from your costs for in-network care.

Contact your health plan to learn:

• Whether your plan covers out-of-network services;
• How payment for out-of-network services is determined;
• Whether you may receive a bill from an out-of-network provider; and
• What deductible, copayment, coinsurance, or other costs you may have to pay.

Cost information given before you receive care may be an estimate. Your final cost may change based on the services you receive, your benefits, and applicable law.

Some providers offer services by telehealth. This may include video or audio-only visits when available and covered by your health plan.

Provider Search shows whether a provider offers telehealth at each service location. Telehealth availability may vary by location. Contact the provider or your health plan if you have questions about available telehealth services or how to use them.

Language assistance and interpreter services are available at no cost when required by your health plan and applicable law.

If you need help in another language, an interpreter, information in an accessible format, or help using Provider Search because of a disability, contact the Member Services number on your member ID card or health plan materials.

Your health plan can tell you about available language assistance, interpreter services, communication assistance, and accessibility services.

Members are entitled to full and equal access to covered services, including members with disabilities, as required under the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.

The Provider Directory Information for All Members above applies to all members. The sections below provide additional information and resources that may apply based on your state or health plan.

Medi-Cal Provider Directory Information
The California Department of Health Care Services (DHCS) makes available to all members information pertaining to Medi-Cal covered services that are carved out of the Medi-Cal managed care Contract in compliance with SHO 24-003.

The links below can help members find Medi-Cal enrolled providers, including pharmacies and behavioral health providers.

•      Fee-for-Service (FFS) Provider Directory:
https://data.chhs.ca.gov/dataset/profile-of-enrolled-medi-cal-fee-for-service-ffs-providers

•      Medi-Cal Rx Provider Directory:
https://medi-calrx.dhcs.ca.gov/home/find-a-pharmacy/

Accessing Community-Based Behavioral Health Services

Provider Search provides information about accessing coverage for Community-Based Behavioral Health Service Providers. These providers offer crisis intervention, urgent care, and stabilization services, including mobile crisis intervention and emergency services.

Some services, such as mobile crisis intervention, may not be available in all locations. Check the "Types of Service" section in Provider Search for more information or contact the provider directly.

The Massachusetts Behavioral Health Help Line (BHHL) can help Massachusetts residents find mental health and substance use treatment and support.

Call or text 833-773-2445 at any time, 24 hours a day, 7 days a week, 365 days a year.

You can also chat online or learn more at www.masshelpline.com.

The Behavioral Health Help Line is free and confidential. Health insurance is not required.

If you cannot find an available in-network provider, contact your health plan for help. Your health plan can explain how you may be able to get covered care from an out-of-network provider when an in-network provider is not available.

For the most current information about appointment availability, contact the provider directly. You may also ask whether another qualified provider in the same practice is available.

For Massachusetts residents, MassCompareCare.gov can help you compare health care costs and quality.

The site provides information about:

1. Providers by specialty, location, and distance;
2. Provider compensation and reimbursement;
3. Cost comparisons with other providers;
4. Health status adjusted total medical expenses; and
5. Quality measures based on a standard set used to evaluate performance.

Visit https://masscomparecare.gov/ for more information.

For consumers in Massachusetts, you may file complaints relating to Provider Directory inaccuracies or provider network inadequacy with the Commonwealth's Division of Insurance.

Visit: https://www.mass.gov/how-to/filing-an-insurance-complaint

Follow the instructions on the website to submit a complaint online or by mail.

You may also contact the Massachusetts Division of Insurance Consumer Service Unit at 617-521-7794.

Make sure you select the network and health plan that apply to your coverage. Provider Search identifies the networks and health plans in which providers and facilities participate.

Your health plan may use network tiers or require referrals for some services. Check your health plan documents or contact your health plan to learn whether these rules apply to you and how they may affect your costs.

When receiving services from an in-network facility, be aware that the facility may have arrangements with emergency room physicians, anesthesiologists, radiologists, laboratories, and other providers who assist in your care. However, these providers may not always participate in your plan's network.

To avoid out-of-network costs and balance billing from non-participating providers, contact your health plan using the Member Services number on your member ID card for more detailed information about whether a provider participates in your network. Federal and Ohio surprise billing laws may provide protections from certain out-of-network costs.

If you reasonably rely on incorrect or misleading provider directory information, your health plan will not increase your financial responsibility in situations protected by Ohio law.

Your health plan also will not increase your financial responsibility because a provider or facility left the network until the provider directory has been updated to show the change.

Contact your health plan if you believe this happened or if you have questions about your costs.

Gender-Affirming Treatment

If you cannot find a provider for gender-affirming treatment, contact your health plan. Your health plan will help identify a gender-affirming treatment provider.

All providers must review, update, and attest to their directory information every 90 days, or sooner if there are changes.

If you are a practitioner with the Council for Affordable Quality Healthcare (CAQH), make sure you authorize Carelon Behavioral Health to access your profile so updates made through CAQH appear in Carelon's Provider Directory.

Facilities, Provider Groups, and non-CAQH Practitioners can update their information through Carelon's Provider Portal or by calling the National Provider Services Line at 800-397-1630, Monday through Friday, from 8 a.m. to 8 p.m. ET.

Carelon Behavioral Health of Pennsylvania, Inc. (Carelon of Pennsylvania) (Medicaid) is a subsidiary of Carelon Behavioral Health Inc (Carelon). Carelon Behavioral Health of Pennsylvania, Inc. provides behavioral health services for applicable Pennsylvania programs and members.

In order to search for a provider, use the drop-down menu and choose the county in which you reside. Upon doing so, you will be able to enter your address and find a provider who is contracted to deliver services in your county. You’ll also be able to see how many miles a provider is from your home address. You may seek services outside of your county of residence if that is your preference.

Care Management staff are available 24 hours a day, 7 days a week should you need assistance in locating a provider of behavioral health services.

Use the following contact information if you are a Carelon of Pennsylvania Medicaid member or assisting a Carelon of Pennsylvania Medicaid member locate a behavioral health provider.

 

Carelon Behavioral Health of California, Inc. (Carelon of California) is a subsidiary of Carelon Behavioral Health, Inc. (Carelon).

The information below applies to applicable Carelon Behavioral Health of California plans and networks.

For Carelon of California plans regulated by the DMHC, the provider directory disclaimer presents California-specific information before other applicable directory information.

If you have an administrative question about eligibility, benefit coverage, or another matter related to the Carelon of California MHSUD or EAP benefit plans, or if you believe you reasonably relied on materially inaccurate, incomplete, or misleading directory information and wish to submit a complaint, you may call Member Services at 800-228-1286 or the telephone number listed in your Combined Evidence of Coverage and Disclosure Form.

You have the right to get an appointment within California’s appointment wait-time standards.

If you cannot get a timely appointment, contact your health plan for help finding an appropriate provider. If you need after-hours care, contact your health plan or provider for assistance.

For more information about appointment wait-time standards, including standards for urgent and routine appointments, visit the California Department of Managed Health Care Timely Access to Care webpage or click here.  

Language assistance, including interpreter services, is available at no cost in all applicable threshold languages and in accessible formats for people with disabilities. You can get an interpreter to help you talk with your doctor or health plan, including during telehealth appointments.

If you have a disability, you can get aids and services when needed to have an equal opportunity to participate in a telehealth appointment. This may include a qualified interpreter or information in another format. These services are also provided at no cost and in a timely manner.

To get an interpreter or ask for written information in your language, call Member Services at 800-228-1286. Someone who speaks your language can help you.

See the Timely Access to Care¹ section above for information about appointment wait times and your right to interpreter services at the time of your appointment.

If you need more help, you can contact the California Department of Managed Health Care, which protects consumers.

Call 888-466-2219 toll-free.

For people with hearing or speech disabilities, call 877-688-9891 (TDD).

You can also visit www.dmhc.ca.gov.

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Google™ translation feature is provided for informational purposes only. Carelon Behavioral Health Inc., and its subsidiaries, are unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information resulting from the translation application tool. Please consult with a translator for accuracy if you are relying on the translation or are using this site for official business. If you have any questions, please call Member Services at 800-228-1286.