Employee Assistance Program
Currently, the Employee Assistance Program (EAP) and behavioral health benefits are being administered by Optum.
EAP services are offered at no cost to those individuals eligible to participate. Receive five EAP visits, per situation, per year at no cost to you.
Opioid/Substance Use Disorder Help
Opioids are strong pain medicines used to relieve moderate to severe pain. They can help you manage pain when you use them the right way. But if you misuse them, they can cause serious harm and even death. Opioid use disorder means using these drugs in a way that keeps you from living the life you want. When your use is out of control, it harms you and your relationships.
Treatment usually includes medicines, group therapy, one or more types of counseling, and drug education. There is no “one-size-fits-all” solution because everyone’s situation is unique. An individualized treatment strategy begins with an assessment by a licensed clinician. In general, treatment options may include one or more of the following:
- Detoxification: medical management of the physical symptoms of withdrawal from drugs or alcohol
- Local, short-term, intensive residential treatment: 24 hour treatment with MD and RN staff
- Medication-assisted treatment: the use of approved medications in combination with therapy to treat substance use disorders
- Intensive outpatient treatment: 3-5 days a week up to 3 hours of individual and group therapy
- Individual substance use disorder counseling: individual therapy with an outpatient provider
- Group therapy: group of patients meet to discuss issues under the guidance of a therapist
Many people with this disorder, and sometimes their families, feel embarrassed or ashamed. Don't let these feelings stand in the way of getting treatment. Remember that the disorder can happen to anyone who uses opioids, no matter what the reason.
If you are enrolled in the state health plan, call Optum today and get the help you need. Call 855-Here4TN (855-437-3486), or go to HERE4TN.com.
EAP and Behavioral Health* Eligibility
State and Higher Education: EAP services are available to all benefits eligible employees and their eligible family members, even if they are not enrolled in medical insurance.
Local Education, Local Government, COBRA and Retirees: EAP services are available to those enrolled in medical insurance as well as benefits eligible (not necessarily enrolled) dependents of employees who are enrolled in medical insurance.
*Behavioral Health benefits are only available to those enrolled in medical insurance.
Master’s level specialists are available around the clock to assist with stress, legal, financial, mediation and work/life services. They can even help you find a network provider, a plumber who works nights, find services for your elderly parents, theater tickets, all-night pharmacies and so much more.
For a full list of mental health and substance use disorder services, click here.
- Preauthorization is required to utilize your Employee Assistance Program. Simply go to Here4TN.com or call 855.437.3486 to obtain your preauthorization. If you prefer to access services over the phone, telephonic counseling is available as well as face-to-face appointments.
State Only: With your manager's approval, you may use work time up to 10 hours annually, to see an EAP provider.
Optum also offers confidential and anonymous access to a wide variety of information and resources on their website at Here4TN.com or by calling 855.437.3486.In addition, your ParTNers EAP can deliver onsite trainings — more than 70 different trainings are available for groups of 15 or more. To access the training catalog and the online training request form, please go to the "Leaders" section on Here4TN.com.
Coming Soon! Take Charge at Work
Starting in the fall of 2017, you will have access to a telephonic program that helps you identify your triggers and recognize and manage symptoms of stress and depression. More details to come, including how to see if you qualify for the program.
Whether you are dealing with a mental health or substance use condition, support is available through your behavioral health coverage. Your enrolled dependents can use these benefits too.
Optum is your behavioral healthcare vendor. Using one of Optum’s network providers gets you the most from this benefit, which is included when you and your dependents enroll in a health plan.
In addition to office visits, this benefit includes virtual visits. What does that mean? You can meet with a provider through private, secure video conferencing. It’s called Telemental Health, and it allows you to get the care you need sooner and in the privacy of your home. EAP is now available through virtual visits as well.
- The copay for Telemental Health is the same as an office visit. To get started, go to Here4TN.com, scroll down, select provider search, and click on Telemental Health to find a provider licensed in Tennessee, or call 855-Here4TN for assistance.
To receive maximum benefit coverage, participants must use a network provider. For assistance finding a network provider, call 855-Here4TN. Preauthorization is required for non-routine outpatient and all inpatient services.
You can learn more by visiting Here4TN.com or calling Optum toll-free at 855.HERE.4.TN (855.437.3486) any time, day or night, to speak confidentially with a trained professional for a referral or preauthorization. A provider directory with a search feature is available on the website.
Participants may see an out-of-network mental health provider without calling for a referral; however, coinsurance and copayments will be higher. Participants are also subject to balance billing by the out-of-network provider, meaning that they will pay the difference between the maximum allowable charge and the actual charge. In addition, participants are at risk of having inpatient benefits totally denied. Certain services are specifically excluded under the terms and conditions of the state group insurance program.
Behavioral Health Service Appeals
If you are in disagreement with a decision or the way a claim has been paid or processed, you or your authorized representative should first call member service at Optum: 855-HERE-4-TN to discuss the issue.
First Level Appeal — If the issue cannot be resolved through member service, the member or his/her authorized representative may file a formal request for internal review or member grievance by contacting Optum. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgement letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of their case from an independent review organization (IRO).
Second Level Appeal — If the member's first level appeal is denied, the member or his/her authorized representative may file a second formal request for internal review or member grievance by contacting Optum. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgement letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of their case from an independent review organization (IRO).
External Review — If the member's first and/or second level internal appeal is denied, the member or his/her authorized representative may choose to request that an IRO review the case and make a final determination. The IRO will communicate their decision to the member. This decision will be final and binding on the member, the plan and the Carrier.
The appeals/grievance form can be initiated by contacting Optum. Members will have 180 days to initiate an internal appeal following notice of an adverse determination. Notification of decisions will be made within the following time frames, and all decision notices shall advise of any further appeal options:
- No later than 72 hours after receipt of the claim for urgent care
- 30 days for denials of non-urgent care not yet received
- 60 days for denials of services already received
Services and Resources
- Work/Life Services – Call 855-Here4TN to find support and referrals for adult/elder services, convenience services, child/parenting services and life learning.
- Legal, Mediation and Financial Services – Call 855-Here4TN to request a no cost consultation and discounted rates for legal, mediation and financial assistance
- Legal and Mediation– One 30-minute telephonic or in-person consultation per issue at no cost and ongoing representation by an attorney or mediator at a 25% discounted rate.
- Financial – One telephonic consultation (30 to 60 minutes) per issue per year
- Online Resources – access via Here4Tn.com
- Over 5,000 articles, videos, podcasts, webinars and newsletters
- Self-assessments and personal plans
Here4TN EAP can deliver onsite and web trainings to your employees — more than 250 different trainings are available for groups of 15 or more. To access the training catalog and the online training request form, please go to the “Leaders” section on Here4TN.
Here are just a few examples of available training topics:
- Collaborative communication
- Healthy Aging
- Generations @ Work
- Documents for life
- The Sandwich Generation
- Resiliency for working parents
- Healthy Food on a budget
- Stress Management 101
- Estate Planning
- Personal finance boot camp
Licensed management consultants are available 24/7 to help leaders with workplace and employee challenges and opportunities. All licensed mental health professionals have a master’s degree and 3-4 years of EAP experience. They can provide coaching and support on a range of workplace issues such as job performance, substance use and inappropriate workplace behavior.
Critical Incident Response Services (CIRS)
An unexpected loss or trauma can affect your entire workplace. Optum has a specialized critical incident intake team available by phone 24/7. Specialists can usually be on-site to provide support within 24-72 hours of the event. The top reasons to provide this resource include grief counseling, reductions in force and medical emergencies/accidents.