The insurance card in your wallet is the best first stop, because your plan usually handles most of the cost of mental health care. Enhance Health Group is in-network with many major carriers, and our Tustin admissions team will check your benefits for you. Telehealth visits often count toward coverage too, and there are options if your plan falls short.
If you or someone you love is in crisis or thinking about suicide, call or text 988 right now.
Financial Assistance for Mental Health Treatment Starts With Your Insurance
Your insurance card carries more of the answer than most people expect, and the first thing to find on it is the name of the carrier and the member ID. Those two details are what let an admissions counselor check what your plan may pay for therapy, a partial hospitalization program (PHP), or an intensive outpatient program (IOP). Enhance Health Group is in-network with Anthem Blue Cross Blue Shield, Aetna, Cigna, Optum, United Healthcare, Blue Shield of California, MHN, Health Net, Ambetter, and Multiplan. We also work with CalPERS and Covered California members.
Being in-network matters because it changes how your plan treats the bill. Plans usually cover more of an in-network provider's charges, and your share tends to be smaller than it would be at a provider outside the plan. Benefits vary by plan, so two people with the same carrier can get different answers about the same program.
Before you call, it helps to have a few things nearby:
- 1Your insurance card, front and back
- 2The name and date of birth of the person who holds the policy, if it isn't you
- 3The level of care you're asking about, if you know it, or a plain description of what's been happening
You don't need a diagnosis or a referral letter to start the conversation. Admissions can talk through what you're seeing and help you work out which level of care to ask your plan about.
The most useful question to ask is what your plan covers for the specific type of care, not whether you have mental health coverage in general. Many plans handle outpatient therapy, PHP, and IOP differently, and the answer for one doesn't predict the answer for another.
What Happens When Admissions Verifies Your Benefits
When you call (714) 862-1907, a member of the Tustin admissions team asks for your carrier, member ID, and the name of the person the policy belongs to. They use those details to contact your insurance company directly, so you don't have to sit on hold with the payer yourself.
The payer's answer is what admissions is after. They ask about your deductible, your copay or coinsurance, and which levels of care your plan may cover. A deductible is the amount you pay before the plan starts sharing costs, and it's often the number that surprises people most. Once admissions has the answers, a counselor explains them in plain terms and tells you what your share could look like for the program you're considering.
Verification is a look at your benefits, and it doesn't commit you to anything. If the numbers don't work for you, you can stop there, ask for other options, or take the information back to your family and decide later. If you want to continue, you move on to admissions, where the team talks with you about what you're experiencing and which level of care fits.
Keep in mind that a verified benefit is the plan's estimate of what it may cover. Benefits vary by plan, and admission to a program is a separate decision from insurance approval.
You can also start without a phone call. The Verify insurance button below takes you to a form on our admissions page, and the team contacts the payer once they have your details. The phone works just as well, and it's fine to call before you've gathered everything. Counselors will tell you what they still need.
How Telehealth Visits Are Covered
Most plans that pay for in-person therapy also pay for the same visit by video, though the copay or coinsurance can differ between carriers. Enhance delivers its outpatient care virtually through virtualtreatmentcenter.com, and admissions checks the telehealth benefit at the same time as the rest of your plan.
Ask your plan, or have admissions ask for you, about three things. First, whether video visits with a behavioral health provider are covered. Second, whether your share is the same as an office visit. Third, whether the plan limits telehealth to certain programs or requires a particular platform. Plans don't always answer these the same way for therapy, medication management, and group sessions, so name the exact service you want.
Telehealth coverage often depends on where you are during the visit. If you travel for work or spend part of the year outside California, mention it when admissions verifies your benefits. Some plans handle that differently, and it's easier to learn it before your first session than after the bill arrives.
On your end, a video visit needs little more than a private room, a phone or computer with a camera, and a steady internet connection. Many people find that a closed door and headphones make it easier to talk openly, especially at home with family around.
Virtual outpatient care fits best when you can stay safe at home and keep up with daily life. If symptoms are more intense, admissions can talk through whether a PHP or IOP in Tustin would be a better match, and they can check how your plan covers those levels of care in the same call.
Covered California, Employer Plans, and CalPERS
Where your plan comes from changes who you talk to first. Each path has its own member services line on the back of your card, and each can give different answers about the same program.
If you bought your plan through Covered California, the carrier on your card (Health Net or Blue Shield of California, for example) is the company that pays claims. Enhance Health Group has a Covered California page that explains how these plans work with our programs. Bring your member ID and the plan name exactly as it appears on the card, since a single carrier can sell several plans with different benefits.
Employer plans vary the most. Two coworkers on the same carrier can have different mental health benefits because the employer picks the plan design. Your HR or benefits office can tell you whether the plan is fully insured or self-funded, and that affects which rules apply. If you're covered under a spouse's or parent's job, use the policyholder's name and date of birth when admissions verifies your benefits.
CalPERS members should look at the plan name on the card, since CalPERS offers more than one health plan. Admissions checks that specific plan, so give them the exact name rather than just "CalPERS."
A few questions are worth asking about any of these plans:
- 1Does the plan require pre-authorization before a PHP or IOP starts?
- 2Is there a separate deductible for behavioral health?
- 3Does the plan cap the number of visits or days for a level of care?
Admissions can ask the payer these for you and explain the answers once they're back.
If Your Plan Doesn't Cover What You Need
A denial or a high deductible isn't always the final answer, and a few steps can change the outcome. Start by asking your plan for the reason in writing. A denial for "not medically necessary" can often be appealed, and your provider can send records that support the request. A denial because a service is out of network is a different problem, and admissions can tell you which kind you're dealing with once the payer responds.
If the plan covers some of the care but not all of it, ask admissions whether a different level of care would fit your benefits better. Some people move from a partial hospitalization program to an intensive outpatient program, or add virtual outpatient care, so the plan pays for more of what they use. Your care team can explain what changes clinically before you decide, so the choice isn't only about cost.
You also have options outside your plan. Orange County Health Care Agency runs a behavioral health line called OC Links at 855-625-4657, and it can point you toward county-funded services. The federal SAMHSA National Helpline at 1-800-662-4357 can also help you find treatment programs that offer lower-cost options.
If the care you need is inpatient or residential, the place to start is still our admissions team. Mental health inpatient and residential care takes place at our sister facility, Eden by Enhance, and admissions can check how your plan treats that level of care in the same conversation.
When the numbers don't add up, call (714) 862-1907 and tell the Tustin team what your plan said. They'll go through the payer's answer with you and talk through the options that make sense for your situation.
Common Questions
Can I get help paying for addiction treatment too?
Yes, many of the same plans cover addiction treatment, and admissions checks those benefits the same way they check mental health benefits. Detox and addiction residential care take place at our sister facility, Embrace Treatment Center, and admissions can look at how your plan treats each level of care in one conversation. Dual diagnosis care is also part of what we offer in Tustin.
Will using my insurance show up on anything my employer sees?
Your employer doesn't receive details about your treatment from us. Insurance companies send an explanation of benefits to the policyholder, so if you're on a spouse's or parent's plan, that person may see a statement listing the service. If that worries you, tell admissions before you start, and they can explain how your plan sends those notices.
What if I don't have insurance at all?
Call admissions anyway and describe your situation. The team can explain what options exist for your circumstances, and they can point you to outside programs if Enhance isn't the right fit financially. Many people without a plan are eligible for coverage they haven't looked at yet, including Medi-Cal or a Covered California plan, so ask about that too.
Does my family member's treatment affect my own coverage?
Each person on a plan has their own benefits record, but deductibles and out-of-pocket limits are often shared across a family. That means one person's PHP or IOP stay can use up part of a family deductible that everyone draws from. Ask admissions to check whether your plan uses individual or family limits, since that changes what the next visit costs.
Do I have to pay anything before I call?
No, calling and verifying your benefits doesn't cost you anything. The team asks for your carrier, member ID, and policyholder details, then contacts the payer on your behalf. You'll hear what your plan may cover and what your share could be before you decide whether to move forward with a program.
