Behavioral Health Services

Behavioral health care includes mental health (your emotional, psychological and social well-being) and substance (alcohol and drug) use disorder treatment and rehabilitation. All members have access to providers and services to help with behavioral health issues

Covered behavioral health services

There are NO copays for behavioral health services offered through AmeriHealth Caritas North Carolina.

You do not need a referral for your first behavioral health or substance use disorder assessment completed in a 12-month period.

Some behavioral health services for people with a mental health disorder, substance use disorder, intellectual/ developmental disability, mental illness, or traumatic brain injury are only available through the Tailored Plans, formerly local management entities/managed care organizations (LMEs/MCOs), and in NC Medicaid Direct. The following behavioral health services are not covered by AmeriHealth Caritas North Carolina, but, if needed, members may access these services through the Tailored Plans, formerly LMEs/MCOs, and NC Medicaid Direct programs:

  • Residential treatment facility services for children and adolescents
  • Child and adolescent day treatment services
  • Intensive in-home services
  • Multi-systemic therapy services
  • Psychiatric residential treatment facilities
  • Assertive community treatment (ACT)
  • Community support team
  • Psychosocial rehabilitation treatments
  • Substance abuse non-medical community residential treatment
  • Substance abuse medically monitored residential treatment
  • Intermediate care facilities for individuals with intellectual disabilities (ICF/IID)
  • Innovations Waiver services
  • Traumatic Brain Injury Waiver services (only available in counties served by LME/MCO Alliance Health)
  • 1915(b)(3) services

If you believe you need access to any of the behavioral health services that AmeriHealth Caritas North Carolina does not provide, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

Emergency services

An emergency is a life-threatening situation where you or another person thinks you need help right away so that you or someone else doesn’t get hurt. If you are having a mental health or drug or alcohol use emergency, act quickly. Call 911. You may also go to an emergency room at a hospital. You do not need to call us first. Emergency services are covered, whether provided by a participating or non-participating provider.

If you have a mental health or substance use disorder emergency, call 911 or call the Behavioral Health Crisis Line immediately at 1-833-712-2262 (TTY 1-866-209-6421).

988 has been designated as the new three-digit dialing code that will route callers to the 988 Suicide & Crisis Lifeline and is now active across the United States. The 988 Suicide & Crisis Lifeline is a suicide prevention network of over 200+ crisis centers that provides 24/7 service via a toll-free hotline with the number 9-8-8. It is available to anyone in suicidal crisis or emotional distress.

Find a provider

Need help finding a mental health and substance use provider? Ask your doctor or contact Member Services at 1-855-375-8811 (TTY 1-866-209-6421). They can also explain mental health and substance use benefits and help you find care and services.

Our Find a Provider search tool makes it even easier for you to find participating mental health and substance use providers based on one or more of the following:

  • Provider name or organization
  • ZIP code
  • Distance from your home
  • Special requirements (examples: elevator, TTY/TDD lines, foreign language spoken or interpreter needed)
  • Certain services

In lieu of services

AmeriHealth Caritas North Carolina offers services or settings that are medically appropriate, cost-effective substitutions for services covered by NC Medicaid. These are called “in lieu of services.” AmeriHealth Caritas North Carolina offers the following in lieu of services:

  • Institute for Mental Disease (IMD) for mental health services for members ages 22 – 64 as an alternative placement for acute psychiatric care in other covered settings. IMD is an acute residential service for adult members who are in need of mental health inpatient services due to imminent risk of harm to self or others, for up to 15 calendar days within a calendar month.

  • Behavioral Health Urgent Care (BHUC), as an alternative to a community hospital emergency department (ED), is a designated service for individuals age 4 years or older experiencing a behavioral health crisis related to a substance use disorder, mental health disorder, and/or intellectual and developmental disabilities (I/DD) diagnosis or any combination of the above. Members have the right to refuse the substitution and to insist upon receiving the original state plan or waiver service instead. Call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) to learn more.

Members have the right to refuse the substitution and to insist upon receiving the original state plan or waiver service instead. Call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) to learn more. Click here to see all Member Rights and Responsibilities.

Opioid Misuse Prevention Program

Opioids are powerful prescription medications that can be the right choice for treating severe pain; however, opioids may also have serious side effects, such as addiction and overdose. AmeriHealth Caritas North Carolina supports for safe and appropriate opioid use through our Opioid Misuse Prevention Program.

If you have any questions about our program, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

Out-of-network health care professionals and providers

There may be times when you get a referral to a provider who is not part of the AmeriHealth Caritas North Carolina network. When that happens, you will need to get approval ahead of time (prior authorization). The prior authorization process is described below.

Prior authorization process

  1. Your health care provider must give AmeriHealth Caritas North Carolina medical information to show the service or medication is medically necessary.
  2. AmeriHealth Caritas North Carolina clinicians or staff review the medical information. The clinicians use clinical guidelines approved by North Carolina Department of Health and Human Services (NCDHHS) to see if the service is medically necessary.
  3. If the request cannot be approved by an AmeriHealth Caritas North Carolina licensed mental health professional, an AmeriHealth Caritas North Carolina doctor will review the request.
  4. If the request is approved, we will contact your health care provider.
  5. If the request is not approved, a letter will be sent to you and your health care provider telling you the reason for the decision.
  6. If you disagree with the decision, you may file a member appeal. Click here to go to the Appeals page.
  7. You may also call Member Services for help in filing a grievance, appeal or state fair hearing.

Please talk to your doctor about the services you need and if they will need prior authorization.
As an AmeriHealth Caritas North Carolina member, you are not responsible to pay for medically necessary covered services.

You may have to pay when any of the following applies:

  • You receive a service from a provider who is not in the AmeriHealth Caritas North Carolina network, and prior authorization was not given to see this provider (except for emergency services).
  • The service provided is not covered by AmeriHealth Caritas North Carolina and your provider told you that it is not covered before you received the service.

Your mental health and substance use benefits and services depend on your age and the type of Medicaid assistance you get.

If you are not sure if you need mental health and/or substance use services, you may call our Rapid Response Outreach Team at 1-833-808-2262.

Out-of-town emergency care

If you are away from home and have a mental health and/or substance use emergency or a life-threatening situation, go to the nearest hospital emergency room. Please let the hospital know that you are a member of AmeriHealth Caritas North Carolina. Ask the hospital to call AmeriHealth Caritas North Carolina Member Services at 1-855-375-8811 (TTY 1-866-209-6421) as soon as possible to let us know about the emergency. You should not get a bill for your care. Please call us right away if you do get one.

Confidentiality

We know your privacy is important to you. It is very important to us, too. AmeriHealth Caritas North Carolina wants you to know we respect your privacy and work to protect it. AmeriHealth Caritas North Carolina staff is required to follow all applicable laws about confidentiality.

Know that:

  • Your records are only viewed by AmeriHealth Caritas North Carolina staff involved with your care or your family’s care.
  • Our providers follow the same state and federal laws as we do 

In general, we do not give out any information about your treatment to outside parties without your written approval. We will use or share only the minimum amount of your medical information needed to do our job. We may use your information:

  • When necessary and permissible, to arrange your treatment and coordinate care with providers.
  • To help resolve a grievance you have about your care.
  • When necessary to pay for your care.
  • When necessary to conduct the basic health care operations of AmeriHealth Caritas North Carolina (including quality or treatment reviews).
  • When it is required by your parish or state to monitor the activities of AmeriHealth Caritas North Carolina.
  • If you or someone else could get hurt. The law says that we must share information to get you or another person out of danger.
  • When you provide your written permission.
  • You can talk to Member Services about how we respect your privacy. You can ask them to send you our Notice of Privacy Practices.