2020 Medicare Behavioral Health Services

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Sometimes there are behavioral health issues beyond your control. You may need help, or want somebody to guide you through the process of getting mental health care. Virginia Premier’s Behavioral Health Team can provide support if you are experiencing behavioral health issues. 

Care and Pregnancy Resources

The behavioral health team can provide support and help you get the care you need by working closely with your Case Manager or Care Coordinator. Virginia Premier has its own network of doctors and community agencies that work with us to meet your treatment goals.

We also provide support for high-risk pregnancies, and our Healthy Heartbeats program rewards you for getting the right prenatal care. Use the links below to learn more:

If you feel you are in immediate danger either to yourself or someone else, please call 911 or go to the nearest emergency room.

Crisis Numbers

Virginia Premier also offers crisis numbers if you are struggling with an issue and want to talk to someone about how to get help. The call is free, just dial the number for your plan:

  • Medicare Advantage Prescription Drug Plan (DSNP & MAPD): 1-844-513-4952

Covered Behavioral Health Services

Medicare Advantage Prescription Drug Plan

Virginia Premier provides coverage for traditional inpatient and outpatient behavioral health and substance abuse services for Virginia Premier Medicare Advantage members. Traditional services are covered at both the individual and group levels of care.

In addition to inpatient mental health hospitalization, Medicare Part B (medical Insurance) helps to pay for these outpatient behavioral health services:

  • A one-time “Welcome to Medicare” preventive visit (you must use within the first 12 months of Part B enrollment)
  • One depression screening per year to include necessary treatment recommendations and referral to services
  • Individual psychotherapy with professionals licensed in the state where you receive the services
  • Group psychotherapy with professionals licensed in the state where you receive the services
  • Family counseling focusing on assisting the Virginia Premier member with your treatment that is provided by a professional licensed in the state where you receive the services
  • Outpatient mental health services for treatment of alcohol and substance use
  • Diagnostic testing to identify problems and ensure receipt of appropriate and effective services
  • Psychiatric evaluation
  • Medication management
  • Medicare-approved prescription drugs
  • A yearly Wellness visit to talk with your doctor or other health care providers about changes in your mental health

How to Access Medicare Behavioral Health Services

For more information about coverage for Medicare behavioral health and substance abuse services, contact Virginia Premier Member Services at 1-877-739-1370, TTY:711 Monday through Friday 8:00 am to 8:00 pm or go to https://www.medicare.gov/coverage/mental-health-care-outpatient.

Trauma Informed Care

Trauma refers to intense and overwhelming experiences that involve serious loss, threat or harm to a person’s physical and/or emotional well-being. These experiences may occur at any time in a person’s life. They may involve a single traumatic event or may be repeated over many years. People often find a way of coping that may work in the short run, but can cause serious harm in the long run.

Virginia Premier’s in-network providers deliver services to members through a trauma-informed care framework.

Substance Abuse Services

Virginia Premier offers a variety of services that help individuals who are struggling with substance use. This includes alcohol and drug use. Addiction is a medical illness, just like diabetes. Many people face addiction, and can benefit from treatment. If you need treatment for substance use, we cover services that can help you.

How to Access Substance Use Services

Talk to your Primary Care Provider (PCP) or call a Virginia Premier Care Coordinator to determine the best option for you and how to get help in substance use services.

To find a substance use provider, you can do any of the following:

  • look in the Provider and Pharmacy Directory
  • visit our website at virginiapremier.com
  • call your Virginia Premier Care Coordinator
  • contact Member Services at 1-800-727-7536, 8:00 am to 5:00 pm, Monday through Friday

If you have any questions or if you are interested in finding out more about Substance Use Services, please do not hesitate to reach out to us. We hope you will take advantage of these services that are a benefit and are available at no cost to you.

Prior Authorizations for Behavioral Health and Substance Abuse

Virginia Premier requires a prior service authorization for:

  • all inpatient behavioral health and substance abuse  referrals to hospitals