Members
Preferred Mental Health Management for Members
PMHM’s unique system of Professionally Guided Care combines a high level of professional review expertise with one of the nation’s largest behavioral Provider Networks. PMHM’s management program produces outstanding patient satisfaction and cost savings. Traditional managed behavioral firms can’t equal PMHM’s level of cost savings or satisfaction.
PMHM’s system increases treatment quality while lowering costs.
Referral Process
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.
MEMBERS
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.

If the situation is truly an emergency, don’t call PMHM,
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: Your preferences (ex. Provider’s gender or language spoken)
Provider’s treatment specialty
Provider’s location

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).
MEMBERS Rights
As a Member, you have the right to know details about PMHM and how we do business, including:

  • The name and title of the staff member who is assisting you
  • What your benefit plan covers
  • How we make our decisions about insurance coverage for treatment
  • Your Member rights and responsibilities
You have the right to know about PMHM’s
Network Providers including:
  • Their specialties
  • Licensures
  • 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.
10,500
Outpatient
Providers
800
Inpatient
Treatment Facilities
National Map of PMHM Providers
National Network
Preferred Mental Health Management (PMHM) has one of the nation’s largest behavioral health networks with more than 10,500 outpatient providers and 800 inpatient treatment facilities. This network offers some of the deepest discounts available. Outpatient providers include psychiatrists, psychologists, licensed clinical social workers and licensed chemical dependency counselors. PMHM’s inpatient rates are flat per-diem fees which include all services
Call Us Today 1 (800) 819-9571
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