Mental Health Services

Highmark Wholecare cares about your mental health and overall well-being. When you need care, your D-SNP includes both inpatient and outpatient mental health coverage.

Types of Mental Health Care Services

Here are a few examples of covered mental health care services you’ll have as a Highmark Wholecare member. Based on your D-SNP, you may also have a $0 copay for some care. Please check your Evidence of Coverage (EOC) for all mental health care coverage.

Outpatient Mental Health Care

As a D-SNP member, you have the right to self-refer to mental health treatment and substance abuse treatment. Your covered services include mental health services provided by a:

• State-licensed psychiatrist or doctor
• Clinical psychologist
• Clinical social worker
• Clinical nurse specialist
• Nurse practitioner
• Physician assistant

You may also have covered services when seen by other Medicare-qualified mental health care professionals as allowed under state law.

Outpatient Hospital Services

Mental health care, including care in a partial-hospitalization program, is covered if a doctor certifies that inpatient treatment would be required without it.

Psychiatric Hospital Inpatient Services

Your D-SNP covers mental health care services that require a hospital stay. Note, you may have lifetime limits for inpatient services in a hospital.

Partial Hospitalization Services

Partial hospitalization is a structured program of active psychiatric treatment provided as a hospital outpatient service or by a community mental health center. It’s more intense care you’d receive in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization.

Telehealth Services and Doctor Office Visits

Telehealth services may be available through an in-network provider and are covered for individual sessions of outpatient mental health care only. Remember to ask your doctor if telehealth is an option for you.

Telehealth covered services include services for:

• A substance abuse disorder or co-occurring mental health disorder, regardless of their location.
• Mental health visits provided by Rural Health Clinics and Federally Qualified Health Centers.
• Diagnosis, evaluation, and treatment of mental health disorders if you meet certain in-person visit criteria. See your EOC for details.