Carelon on the behavioral health line of your card.
If the behavioral health number on your card goes to Carelon, your behavioral health benefit is managed separately from your medical benefit. The medical logo on the front can say something else entirely. That split is normal and it is worth understanding before you call anyone.
Shift is out of network for behavioral health benefits managed by Carelon.
We are not part of any commercial carrier or behavioral health network. The question that decides what you pay is what your plan pays out of network for intensive outpatient care, and that sits in your plan document, not in the administrator's name. We read it and give you the number first.
What we can say about your plan before we read it.
Covered by many PPO plans. We check your benefits first.
We do not waive cost shares, we do not tell you a number we have not verified, and we do not promise a result. We read your plan, we tell you what it pays toward intensive outpatient care, and you decide after that.
What your plan sets, and what we do about it.
The numbers are not on this page on purpose. Yours are specific to your plan and your plan year, and we pull them with you.
What your plan document sets
- An allowed amount for each kind of visit or day of care.
- A deductible you meet before the plan starts paying its share.
- A coinsurance split that applies after the deductible.
- An out-of-pocket maximum for the plan year.
- An authorization step for intensive outpatient care.
What we do
- Call the behavioral health number on the back of your card and pull the out-of-network figures for the level of care you need.
- Turn those figures into the dollar cost of a week of treatment and give you that number in writing.
- Open the authorization and stay on the case through review and renewal.
- Bill the plan directly, so you are not fronting the claim and chasing a reimbursement.
One card, two benefits, two sets of rules.
When behavioral health is carved out, the authorization, the network and the allowed amounts can all be set differently from the medical side of the same plan. People find this out in the middle of a crisis. Better to find it out now.
Send both numbers
The medical number and the behavioral health number, plus the member ID and the group number. We call the behavioral health line, because that is the one that authorizes intensive outpatient care.
Check your benefits If you have been told no alreadyAsk which benefit was checked
A no from the medical side is not an answer about the behavioral health benefit. We ask the question again on the right line and tell you what came back.
How out-of-network worksCarelon, answered plainly.
My medical card says one company and the behavioral health line says Carelon. Which one matters?
For intensive outpatient care, the behavioral health line. That is where the benefit, the authorization and the allowed amount for this level of care live. We call that line and read what it returns.
Is Shift in the Carelon network?
No. We are out of network for every commercial carrier and every behavioral health administrator. Your plan may still pay a real share out of network, and we tell you what share before you start.
Does a carve-out mean worse behavioral health coverage?
Not on its own. It means the rules are written in a different place. Sometimes the out-of-network terms on a carve-out are better than the medical side, sometimes worse. We read yours rather than guess.
Who handles the authorization?
We do. We open it, submit the clinical documentation, and stay on the case through review and renewal.
Send the card and we call the behavioral health line.
Member ID, group number, and the behavioral health phone number from the back. We come back with your out-of-network deductible, coinsurance and out-of-pocket maximum, and the cost of a week of intensive outpatient care.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service.
Not the card you hold.
Shift also publishes a page for Magellan, Aetna, Cigna, Anthem and Elevance, UnitedHealthcare, UMR, Blue Shield of California, Kaiser and union and Taft-Hartley funds.
Background reading: how out-of-network works, out-of-network for IOP and PHP in plain English, and the program itself.