When you call to access “behavioral health” services, you will first talk with a PMHM Patient Relations Coordinator (“PRC”). The PRC will explain your benefits and answer any questions you may have about the referral process. If your call is an emergency, the PRC will connect you with a PMHM Staff Psychologist who will help stabilize the situation and immediately refer you for medical or mental health treatment.
If the situation is truly an emergency, don’t call PMHM first, immediately DIAL 911.
If your call is not an emergency, the PRC will explain the referral process. He or she will explain your insurance benefits and gather information to determine your eligibility. You will then speak with a PMHM Staff Psychologist who will conduct a brief interview. Working with you, the PMHM Psychologist will develop an initial treatment action plan. The PMHM Psychologist will then refer you to a provider in your area for a specified number of visits. PMHM will follow your progress with your Provider in order to determine if your treatment goals have been met or if you require more treatment.
In selecting a Network Provider for you to see, the Staff Psychologist considers a number of factors, including:
Once the PMHM Psychologist has located an appropriate Network Provider for you, the PRC will create a Treatment Referral Authorization which is sent to you. PMHM also sends your Provider a referral authorization containing the treatment plan information.
If you do not need mental health treatment, but have more of a life problem, the PMHM Psychologist may refer you to an appropriate community agency to assist you (child care, elder care, debt management, legal difficulties, etc).
As a Member, you have the right to know details about PMHM and how we do business, including:
You have the right to know about PMHM’s Network Providers including:
- Their specialties
- Address, phone and office hours of clinic or facility
- Demographic information such as gender, race, language spoken, etc. (if available)
- You have the right to have your treatment information and diagnosis remain confidential, except as required by State or Federal law. Regarding the release of your treatment information to others, including your family members, PMHM will not release information without a signed form from you or your legal guardian permitting us to do so.
- In your interactions with PMHM’ staff, you have the right to be treated with privacy, courtesy and respect.
- You have the right to participate in the decisions which are made about your treatment.
- You have the right to discuss your best treatment options with your Provider regardless of the cost or your insurance coverage.
- You have the right to discuss what you feel your rights and responsibilities should be with PMHM.
- You have the right to make informal or formal complaints about PMHM’s staff, services or the care given by Providers.
- You have the right to undertake a formal appeal if you disagree with a decision made by PMHM about your treatment coverage.
- You have the right to designate another person to speak to PMHM on your behalf.
- You have the right to understand your insurance coverage and how to seek treatment.
- You have the right to receive timely care consistent with your individual needs.
- You have the right to know all the information about any treatment charges you receive, even if the insurance company is making payment.
MEMBERS – Frequently Asked Questions
How do Members access PMHM benefits?
PMHM is a behavioral managed care firm. It is not an insurance company. PMHM often works with insurance companies or payers to precertify treatment and authorize payment for behavioral treatment.
What do I do in an emergency?
Always call 911 and seek emergency assistance. Do not wait to talk with PMHM first.
How do I receive a referral for behavioral benefits?
Covered Members access PMHM’s services by calling 800-776-4357. The phones are staffed 24-hours a day, seven days a week. During PMHM’s normal business hours of 8 a.m. to 5 p.m., Monday-Friday CST, the toll-free line is answered directly by a Patient Relations Coordinator (PRC). On weekends and holidays, the 800 line is answered through a medically medically-oriented professional service with PMHM psychologists on call and available by pager and cellular phone. In an emergency situation, the service can connect the caller directly to a PMHM psychologist.
What information do I need when I call PMHM?
You will need your employer’s name as well as group number and individual Member number.
Will my employer know if I call PMHM or what I called about?
No. PMHM’s referral records are completely confidential.
How does PMHM ensure client/patient confidentiality?
PMHM is bound by certain confidentiality policies, dictated by state and federal laws as well as ethical practice constraints. No identifying information is released regarding an individual’s use of PMHM’s services, without specific, written consent from the individual. Exceptions to this occur only in situations in which legal obligations exist to provide information to designated authorities or in clinically appropriate circumstances. Statistical information, shared with the employer, does not contain any information which would identify a Member.
Does PMHM have Providers in my area?
PMHM has Providers in all 50 states and Puerto Rico. Chances are excellent that we have a Provider located near you.
How do I know who the Preferred Providers are in my area?
You may call PMHM at 800-776-4357 and you will speak with a Patient Relations Coordinator or Staff Psychologist who will match you with a Provider in your area.
Do I need to call PMHM to use my behavioral health benefit?
That depends on your group’s plan, however, it is always good to call PMHM to obtain your in and out-of-network benefits.
What if the Provider I want is not in PMHM’s network?
You may have the Provider contact us and we will send him or her an application.
What if after I visit the PMHM Network Provider I don’t like him or her?
Just call PMHM and let us know. We will gladly refer you to a different Network Provider that better meets your needs.
What is “pre-cert”?
Pre-cert is short for precertification. PMHM often pre-certifies care. This means that before any treatment is provided, we authorize the treatment for a specific number of days or sessions. This insures that insurance will reimburse your Provider for your care.
If I need to mail claims to PMHM, what address do I use?
Mail claims to PMHM at:
7309 E. 21st Street North, Suite 110
Wichita, KS 67206
What do I do if my claim is denied?
You may appeal this decision by requesting an appeal in writing from PMHM. In your correspondence, please provide all pertinent information such as the Member’s identifying information, the patient’s name and address and also the Provider’s information. You may send your appeal request to: Preferred Mental Health Management, LLC, 7309 E. 21st Street North, Suite 110 Wichita, KS 67206
What type of multi-lingual services does PMHM offer?
PMHM has 24-hour access to a comprehensive language translation service. Utilizing this service, PMHM is able to access a translator within five minutes of the initial call. This translation service enables PMHM to effectively meet the service needs of all of its Members. PMHM also has many multi-lingual providers in its Provider Network.
MEMBER – Responsibilities
As a Member, you have the following responsibilities with regard to your treatment:
- You have the responsibility to provide PMHM with all previous treatment records that it may need to arrange your care.
- You have the responsibility to actively work with your Provider to develop your treatment plan and to learn about your condition.
- You have the responsibility to follow the treatment plan agreed upon by you and your Provider.
- You have the responsibility to help PMHM obtain information about any out of network treatment you are receiving or have received.
- You have the responsibility to notify PMHM and your Provider if your demographic information changes (i.e. name, address, phone number, etc.)
MEMBERS – Appeals
PMHM’s Professionally Guided Care Program SM seeks to ensure that each patient receives the correct treatment in the most appropriate treatment setting. After the expiration of PMHM’s initial authorization, the Provider may request more treatment sessions or days as required. Regardless of PMHM’s authorization, with regard to benefit payment, the Provider or Facility must provide all of the treatment each patient requires.
In the event that PMHM denies further benefit payments, the Member may initiate an appeal. PMHM’s Case Management Program consists of a three-tiered approach, incorporating peer review initially and independent reviewers at the highest levels of appeal. PMHM’s standards for Clinical Appeals conduct are one (1) business day for expedited appeals, and ten (10) business days for standard appeals with a chart review.
For more information about PMHM’s Appeals Process or to initiate an appeal, please call 800-776-4357.