1. The member calls the toll-free 24-hour PacifiCare Behavioral
Health number.
2. The PBH clinical services representative checks the
member's eligibility, gathers basic demographic information
and helps determine the type of services the member is seeking.
3. The PBH clinical services representative conducts an
assessment. The member will be asked questions about:
The severity of the problem he/she is experiencing
How the problem may be affecting family/ home life,
social activities, and work/school performance
Relevant prior history.
4. The PBH clinical services representative matches the
member with an appropriate PBH contracted group practice
or individual provider based on the member's needs. PBH
makes every attempt to ensure that members are provided
services in a culturally competent manner, including those
members with limited English proficiency, diverse cultural
backgrounds and physical and mental disabilities.
5. The member is then referred to the provider and instructed
to call for an appointment. The provider is authorized for
a specific number of visits over a specified period of time.
