Contacting the Program
To receive the highest level of benefits, you must call the MHSU Program before seeking services from a mental health or substance use care provider.
| Call 1-877-769-7447 | Press or say 3 | Available 24/7 |
In an emergency, go to the nearest emergency department. You (or someone you designate) should call the MHSU Program within 48 hours (or as soon as reasonably possible) of being admitted for emergency care.
Clinical Referral Line
The Clinical Referral Line is staffed by licensed clinicians who can:
- Refer you to providers who best match your needs
- Help you schedule an appointment
- Arrange for you to receive network-level benefits from a local provider if there are no network providers in your area
You will receive confidential help when you call.
| Call 1-877-769-7447 | Press or say 3 for MHSU Program, then press or say 3 for the Clinical Referral Line | Available 24/7 |
Precertification
Some services require precertification from the program administrator before you receive them. Call the MHSU Program to learn more about the process.
Precertification required:
- Intensive outpatient program for mental health
- 23-hour bed for mental health or substance use disorder
- 72-hour bed for mental health or substance use disorder
- Outpatient detoxification
- Transcranial Magnetic Stimulation (TMS)
- Applied Behavioral Analysis (ABA)
- Group home
- Halfway house
- Partial hospitalization for mental health
Precertification required unless you use an OASAS-certified Network Facility located within New York State:
- Structured outpatient program for substance use disorder
- Residential treatment center for substance use disorder
- Partial hospitalization for substance use disorder
Precertification required unless it is for a covered individual under 18 years of age and at an OMH-certified Network Facility located within New York State:
- Residential treatment center for mental health
Network and Non-Network Coverage
SEHP uses The Empire Plan network for MHSU benefits. The network includes physicians, providers and facilities.
The program administrator must certify all covered services as medically necessary, regardless of whether you use network or non-network coverage.
If the program administrator does not certify your inpatient or outpatient treatment as medically necessary, you will not receive any benefits. You will be responsible for the full cost of care.
When you use a network provider or facility, you pay applicable copayments for covered services. Most types of visits to a network provider are subject to a 15-visit per person annual limit.
Use the provider directory to find providers and facilities that are part of the network.
Non-network coverage applies when:
- You use a physician, provider or facility who is not in The Empire Plan network
- You exceed the 15-visit annual limit
Non-network coverage is limited, and your out-of-pocket costs will be higher.
Inpatient and Outpatient Services
SEHP coverage includes coverage benefits for both inpatient and outpatient services. The amount you pay for service depends on the type of service and whether you use a network or non-network provider.