Mental health services

Coverage varies depending on plan. To verify your coverage and get information about your benefits, call the Behavioral Health Department at 800.673.8043 (TTY 711) during business hours. Crisis support is available 24 hours a day, seven days a week.

It is important to understand what type of plan you have before you consider your treatment options. Some plans have out of network benefits and others do not. We encourage you log in to find out what type of plan you have and to review your coverage prior to deciding about next steps. We have staff available during business hours to help you understand your benefit and get more information about treatment options. Call 800.673.8043 (TTY 711).

Prior authorization (PA) is a term that communicates to your provider the need to submit a request for your treatment. PA is needed for some outpatient treatment and all partial hospital, residential, and inpatient treatment. The provider you choose for treatment will request prior authorization on your behalf – you do not need to do this. Our Utilization Review Team will review the request to ensure that the treatment is medically necessary. If there are questions, concerns, or more information needed – we will work directly with your provider to coordinate.

Transcranial Magnetic Stimulation (TMS) is covered by most Priority Health Commercial, Individual MyPriority, and Medicare plans. Prior Authorization is required. For more information, please call 

800.673.8043 (TTY 711) to speak with a behavioral health specialist.

If you have Priority Health Medicaid, please inquire about this level of care with your local Community Mental Health Center.

Electroconvulsive Therapy (ECT) is covered by most Priority Health Commercial, Individual MyPriority, and Medicare plans. Prior Authorization is not required when the outpatient treatment physician is in network with Priority Health. If the outpatient treatment physician is out of network with Priority Health, Prior Authorization is required. In addition, Prior Authorization is required when the treatment is being done while you are inpatient at an in or out of network facility. For more information, please call 800.673.8043 to speak with a behavioral health specialist.

If you have Priority Health Medicaid, please inquire about this level of care with your local Community Mental Health Center.

For medication questions, please call Customer Service using the number on the back of your member ID card or call 800.942.0954 and follow the prompts to speak with staff in the Pharmacy Department.

If you have an out-of-network benefit, you may be able to see a provider or receive treatment from an out of network facility. Be aware that out of pocket costs may be higher when the provider does not hold a contract with Priority Health. You may end up paying more out of pocket and/or paying for services that Priority Health does not cover. This is referred to as balanced billing (see below question for more information).

Another advantage of staying in-network is that your health plan works with participating treatment centers to ensure that they are providing evidence-based treatment.

Our Find a Doctor tool is a great way to search online for individual behavioral health providers that are in network in your area. This information is also available over the phone by calling the Behavioral Health Department at 800.673.8043 (TTY 711).

When you go out-of-network, you run the risk of being charged more than the reasonable and customary guidelines followed by Priority Health. The out-of-network provider/facility is not held to a contract and can bill you for the difference between what the treatment cost at their office/facility and what the insurance company paid. Staying in-network can help you avoid those additional costs. If you have more questions about balance billing, call 800.673.8043 (TTY 711) to speak with a behavioral health specialist.

Outpatient therapy can be provided in-person or virtually. Our Find a Doctor tool is a great way to search online for individual behavioral health providers that are in network in your area. This information is also available over the phone by calling the Behavioral Health Department at 800.673.8043 (TTY 711). Crisis support is available 24 hours a day, seven days a week.

If you live outside of Michigan and have a Priority Health employer-based commercial plan, you may have access to Cigna’s outpatient provider network. Please call the Behavioral Health Department to verify your plan coverage and access to the Cigna network.

Do you have a Priority Health Medicare plan (non-DSNP)? You can see any Medicare-participating provider outside of the lower peninsula of Michigan and pay in-network cost-share. You can also utilize the Multiplan network to make finding out-of-state providers even easier. Learn more here.

Every experience navigating a mental health condition is unique in its own way. Similarly, the plan for your treatment will be too. There is no “one size fits all” for how you live your life alongside this condition. Click below to read about the evidence-based treatment that may be available to you.

What is it?

This service provides a therapeutic space to process thoughts, feelings, and behaviors while gaining skills for healthy coping. Outpatient therapy allows you to receive treatment while remaining at home or in the community. Sessions can occur weekly, bi-weekly, or monthly and focus on an array of concerns including coping with symptoms of a substance use disorder, understanding the disorder, relapse prevention, building self-esteem, gaining insight into relationships, dealing with strong emotions, or coping with a traumatic or life altering event(s). Many providers offer this service virtually as well as in person.

What types of clinicians provide this service?

• Licensed Professional Counselor
• Psychiatrist
• Clinical Social Worker
• Psychologist
• Licensed Marriage and Family Therapist.

For more information about how these providers differ in treatment, expertise, and training – click here: National Alliance on Mental Illness - Types of Providers

How long will I be in outpatient therapy?
The length of time spent in outpatient therapy will depend on the severity of your symptoms, whether there are other barriers, and how quickly goals are met. You are encouraged to have regular conversations with your provider about how the process is going and what next steps may look like.

What is it?

This service provides a therapeutic space to meet with a clinician who will complete a psychiatric evaluation, help determine a diagnosis, and can prescribe psychiatric medication to help manage symptoms if needed. Frequency of visits is based on level of need and medication monitoring guidelines. Many providers offer this service virtually as well as in person.

What types of clinicians provide this service?

• Psychiatrist
• Nurse Practitioner
• Physician Assistant

For more information about how these providers differ in treatment, expertise, and training – click here:

National Alliance on Mental Illness - Types of Providers

Priority Health partners with several outpatient providers who offer intensive, community-based outpatient mental health treatment. The program is known as Community Care Management and gives you access to a therapist, medication management, and care coordination. The program allows you to see a therapist more frequently (up to 3 times weekly) at home, in the community, office, or virtually. There are some program restrictions based on plan and location. For more information and to speak with someone about whether you are eligible, contact our Behavioral Health Department at 800.673.8043 (TTY 711).

Download our Community Care Management flyer here for more information.

This service is like outpatient therapy however more intensive and frequent. Often the treatment is five days per week up to three hours a day, however, some programs are more flexible.

What types of clinicians provide this service?

This level of care is provided by an outpatient group practice or outpatient clinic which can be staffed with several different types of clinicians.

How long will I be in intensive outpatient therapy?

Treatment in this level of care can last five to eight weeks – and could be longer depending on your clinical needs.

What is it?

This service is often referred to as “day treatment” and is the most intensive service that is offered on an outpatient basis. Treatment includes individual therapy, group therapy, and access to a clinician who can manage psychiatric medications if needed. Treatment will occur five days a week for six hours each day.

What types of practices provide this service?

This level of care can often be found embedded within an inpatient hospital or is offered at an outpatient clinic.

What is it?

This service provides a supportive living environment alongside an intensive treatment program with access to individual and group therapy, psychiatric medication management, and other supports. Residential programs are often separated by whether they treat primary mental health or substance use concerns.

What types of programs provide this service?

Most substance use disorder residential programs are not connected to a hospital system, and access is through the program’s intake process. Other substance use residential programs are connected to a hospital system and may require going to the ER for admission.

How long will I be in a residential program?

Your health plan may cover short term substance use residential treatment which is based on individual treatment needs. Length of stay is determined by intensity of symptoms that are reported by the provider. Most substance use residential programs cover 10 - 14 days. Length of stay reviews are done regularly and consider what physical and psychological symptoms you are experiencing. These reviews also consider if there are interpersonal stressors, whether you have complex medical and psychological needs, whether you are at a high risk of relapse, how much progress you are making towards learning new coping skills, and how committed you are to your recovery plan if you were to be discharged.

If you are not satisfied with the coverage decision made for your treatment, you or the provider can file an appeal. Learn how here.

What is it?

This service is the most intense level of care and provides stabilization for someone who is experiencing an acute mental health concern and requires 24/7 monitoring in a locked facility.

What types of programs provide this service?

Some hospitals have this level of care embedded. There are some stand-alone programs as well.

In addition to the resources available through your plan, you can get a range of support and information from other organizations, including:

• American Psychological Association
• Centers for Disease Control & Prevention
• Child Mind Institute
• Mental Health America
• National Alliance on Mental Illness
• National Institute of Mental Health
• The Trevor Project
• 988 Suicide and Crisis Lifeline
• Priority Health ThinkHealth