IEHP Guide for Addiction and Mental Health Care

If you have IEHP (Inland Empire Health Plan) and you are trying to get help for addiction or a mental health concern, the hardest part is often not admitting you need support. It is navigating coverage rules, referrals, and “who do I call first?” while you are already overwhelmed.

This guide is written to help you use your benefits in real life. You will learn how IEHP behavioral health benefits typically work, how to use the IEHP provider search, what IEHP prior authorization means, and what to do if you hit a denial or delay. While coverage details vary by plan and medical need, the steps below will help you get clearer answers faster.

If you are in immediate danger or someone has overdosed, call 911. If you are worried about overdose risk, you can also call 988 for crisis support and guidance.

What is IEHP?

IEHP stands for Inland Empire Health Plan. It is a major health plan serving parts of Southern California, especially Riverside County and San Bernardino County. Many members access IEHP through IEHP Medi-Cal (California Medicaid managed care), and some may have Medicare-related options depending on eligibility.

For people seeking help with addiction, depression, anxiety, trauma, or other concerns, the key phrase to know is behavioral health. Behavioral health is the umbrella that can include mental health care and substance use disorder (SUD) services.

Does IEHP cover addiction treatment and mental health care?

In many cases, yes. IEHP plans commonly include coverage for medically necessary behavioral health services. The exact services covered and how you access them depend on:

• Your plan type (for example, IEHP Medi-Cal)
• Whether a provider or program is in-network
• Clinical “medical necessity” criteria
• Whether IEHP prior authorization is required for a service
• Whether you need a referral
• Your level of care needs (outpatient vs. higher-intensity services)

Many people feel stuck because they do not know which level of care they “qualify” for. A good next step is often a professional assessment. It helps determine what you need clinically, and it creates documentation that can support coverage requests.

Common services that may be covered under IEHP behavioral health

Coverage varies, but these are common categories that may be available when medically necessary and accessed appropriately:

Mental health services

• Outpatient therapy (individual, group, family counseling)
• Psychiatry visits and medication management
• Care coordination for more complex needs
• Crisis services and stabilization support

Substance use disorder services

• Screening and assessment for substance use
• Outpatient counseling and recovery support services
• Intensive outpatient programs (IOP) or structured outpatient services
• Withdrawal management or detox services (when clinically indicated)
• Residential treatment or inpatient services for more severe cases (often requires authorization)
• Medication treatment for opioid use disorder or alcohol use disorder when appropriate

It is also common for people to need help with both mental health and substance use at the same time. Integrated care is often called co-occurring disorders or dual diagnosis treatment. DAN has a helpful overview here:

co-occurring disorders and dual diagnosis care
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How to check your IEHP coverage step by step

When you are under stress, it helps to follow a script. Here is a simple process that works for many members.

Step 1: Get your member information in front of you

• Your IEHP member ID card
• Your date of birth and address on file
• A notebook or notes app (you will want names, dates, and call reference numbers)

Step 2: Call IEHP Member Services and ask for behavioral health

Ask to be routed to the department that handles IEHP behavioral health and substance use services for your specific plan.

Questions to ask IEHP Member Services

• “What behavioral health and substance use disorder services are covered under my plan?”
• “Do I need a referral from my primary care provider for therapy, psychiatry, IOP, or residential treatment?”
• “Which services require IEHP prior authorization?”
• “What are my costs, such as copays, if any?”
• “How do I find in-network providers who are accepting new patients?”
• “If I cannot find an available provider, what is the next step?”

Tip: if you are getting bounced between departments, ask one clear question:
“Who administers my substance use disorder benefits for my plan, and what is the direct number to access services?”

Step 3: Use the IEHP provider search, then verify directly

The IEHP provider search can help you locate in-network options. Provider directories can be out of date, so treat the directory as a starting list, then confirm with the provider.

When you call a provider, ask:

• “Are you currently in-network with IEHP for my plan?”
• “Are you accepting new IEHP patients?”
• “Do you offer telehealth?”
• “Do you provide SUD services or do you refer out?”
• “If I need a higher level of care, can you help with the referral and documentation?”

If you are comparing programs, it can help to understand what rehab facilities typically do (and what questions to ask). See:

what rehab facilities do and how they support recovery
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IEHP prior authorization explained in plain English

IEHP prior authorization means IEHP may need to approve a service before it is covered. Prior authorization is more common for higher-intensity or higher-cost services, and it typically requires documentation showing medical necessity.

If a provider tells you authorization is needed, ask these questions:

• “Will your office submit the authorization request to IEHP for me?”
• “What records are you sending (assessment, diagnosis, treatment plan, risk factors)?”
• “How long does approval usually take?”
• “If this is urgent, is there an expedited option?”
• “What should I do while we wait, so I do not lose momentum?”

If you are waiting on an authorization decision and safety is a concern, do not wait alone. Use crisis resources, seek urgent evaluation, or go to an emergency department if you feel at risk of harming yourself or experiencing dangerous withdrawal.

How to choose the right level of care

People often ask, “What does IEHP cover?” The more helpful question is, “What level of care is medically appropriate?” Coverage decisions often follow that.

Outpatient counseling

Typically appropriate when symptoms are mild to moderate, you can maintain daily responsibilities, and you have a reasonably stable living situation.

Intensive outpatient program

IOP is often a step up when weekly therapy is not enough. It can be helpful if you need structured support multiple times per week but do not require 24/7 monitoring.

Withdrawal management or detox

Detox is not “treatment” by itself, but it can be the safest entry point for certain substances. Alcohol and benzodiazepine withdrawal can be medically dangerous. Opioid withdrawal is often not life-threatening but can be severe and can increase relapse risk.

Residential or inpatient treatment

Residential care can be appropriate when risk of relapse is high, the home environment is unsafe, symptoms are severe, or there are co-occurring mental health issues that require close support. This level of care commonly requires strong documentation and prior authorization.

If you want to understand how clinicians decide what level of care is medically necessary (which can affect authorization decisions), this ASAM Criteria overview is a helpful explainer:

Barriers IEHP members run into and what to do next

Barrier 1: “We do not accept IEHP” or “We are not taking new patients”

This is common and it is not your fault. If it happens:

• Call IEHP Member Services and ask for more in-network options with availability.
• Ask if telehealth providers are available for therapy or psychiatry.
• Ask the plan what to do if there is a network access issue (for example, no appointments within a reasonable timeframe).

Barrier 2: You are told “mental health” and “substance use” are different systems

Sometimes benefits are coordinated across different networks or county systems. If you feel like you are being transferred in circles, be direct:

• “Who manages my substance use disorder treatment benefits for my specific plan?”
• “What is the direct line for SUD intake or authorization?”
• “Can you document in my file that I requested help locating an in-network SUD provider?”

Barrier 3: A service is denied

Denials can feel personal, but they are often administrative or documentation-based. If you receive a denial:

• Ask for the denial reason in writing and save it.
• Ask what criteria were not met and what documentation is missing.
• Ask your provider to review the denial and consider submitting additional clinical justification.
• Ask IEHP how to file an appeal, including deadlines.

Here is a short explainer on the insurance claim process and why a service can be paid, denied, or appealed:

If you are trying to arrange detox specifically, you may also want to read:

Detox Centers That Take IEHP and How to Get In Network
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If you are considering what happens after a higher level of care, transitional support (like a halfway house) can be part of maintaining momentum in recovery:

what a halfway house is and how it supports recovery housing
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How to prepare for your first appointment so you get help faster

The first call or assessment often determines what happens next. Having a few details ready can reduce delays:

• Substances used, amount, and how often
• Last use date and time
• Withdrawal symptoms (if any)
• Past treatment attempts and what helped
• Mental health symptoms, including sleep and mood changes
• Current medications, including prescriptions and over-the-counter
• Any overdose history or safety concerns

If you are supporting a loved one, you can still call and ask for general guidance on access and next steps, even if the plan cannot discuss private details without the member’s permission.

IEHP and your rights to medically necessary care

People with addiction and mental health symptoms sometimes internalize delays as “proof” they do not deserve care. You do. Addiction is a treatable health condition, and timely care matters.

If you keep hitting dead ends, document everything:

• Date and time of each call
• Who you spoke with
• Any reference number
• What you were told to do next

This paper trail helps when you request escalation, file an appeal, or need a clearer explanation of next steps.

If you’re also trying to support sleep, stress, and overall wellness while you pursue clinical care, you may benefit from holistic mental health resources as an add-on (not a replacement) to evidence-based treatment:

mental health support options and wellness resources
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