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Insurance routes · 16 pages

Insurance routes

Plan-by-plan walkthroughs with the exact scripts — Kaiser, Medi-Cal, Anthem, Blue Shield and more. The 10-business-day law applies to nearly all of them.

OUT-OF-NETWORK

"I don't take insurance" doesn't mean you can't use yours. The superbill route.

A superbill turns a cash-pay therapist into a partly-reimbursed one — often 50–80% back after deductible on PPO plans. The 4-step route with real math.

AETNA

Aetna covers therapy. The route — and the self-funded catch most members hit.

Many California Aetna members are on self-funded employer plans where state deadlines don't bind. What still protects you, and the scripts.

ANTHEM

Anthem covers therapy. Here's the route through California's biggest network.

Anthem members have the 10-day right, a huge PPO network, and superbill leverage. The scripts, the phone numbers, and the self-funded catch.

BLUE SHIELD

Blue Shield of California covers therapy. Here's the route.

Blue Shield members hold the 10-day right. How to get names that answer, force out-of-network coverage when they don't, and escalate free.

COVERED CALIFORNIA

Buying a Covered California plan? Here's how to pick one that's good for therapy.

Every Covered California plan carries the 10-day right and full parity. The real differences: metal tiers, copay structures, and networks. The math.

CIGNA

Cigna covers therapy. Here's the route through Evernorth.

Cigna behavioral health runs through Evernorth. The scripts for names that answer, the self-funded check, and the free-session benefit inside.

HEALTH NET

Health Net covers therapy. Which door depends on which Health Net you have.

Commercial, Covered California, or Medi-Cal — Health Net runs all three, and the therapy route differs. Sort your card, then use the scripts.

KAISER

Kaiser owes you a therapy appointment within 10 business days. Here's how to get it.

Kaiser must offer you a mental health appointment within 10 business days — including follow-ups. The exact scripts to use, and what to do when they miss.

MEDI-CAL

Medi-Cal covers therapy. Free. Here's the door that actually opens.

Medi-Cal covers therapy at $0. Two doors — your health plan or your county — and a law that says neither can turn you away. Scripts included.

LOS ANGELES COUNTY

Medi-Cal therapy in Los Angeles County: one phone number opens the whole system

L.A. Care or Health Net for everyday needs, DMH Help Line (800) 854-7771 for specialty care — 24/7. Exact scripts for both doors.

ORANGE COUNTY

Medi-Cal therapy in Orange County: one plan, one card, two useful numbers

In OC, nearly every Medi-Cal member is on CalOptima. Call CalOptima behavioral health for everyday needs, OC Links (855) 625-4657 for specialty care. $0.

RIVERSIDE COUNTY

Medi-Cal therapy in Riverside County: IEHP is the fast lane most people don't use

Most Riverside Medi-Cal members have IEHP — which runs its own behavioral health intake. For specialty care, the CARES Line: (800) 706-7500. $0 either way.

SACRAMENTO COUNTY

Medi-Cal therapy in Sacramento County: four plans, one Access Team, and an online form that works

Sacramento Medi-Cal members can request county mental health care by phone — (916) 875-1055 — or online. Plus the 10-day rule for your health plan. $0.

SAN DIEGO COUNTY

Medi-Cal therapy in San Diego County: the Access & Crisis Line does the sorting for you

San Diego's Access & Crisis Line — (888) 724-7240, 24/7, licensed clinicians answering — screens you and routes you to $0 Medi-Cal therapy. Here's the script.

UNITEDHEALTHCARE

UnitedHealthcare covers therapy — through Optum. Here's the route.

UHC members reach therapy through Optum Behavioral Health and the Live and Work Well portal. The scripts, the clock, and the escalations.

EAP

Your job probably already pays for therapy. Here's the EAP decoder.

Most California employers offer an EAP: free therapy sessions, no insurance, no diagnosis on file. How to find yours, what to say, and the catches.