How to Request Services
Ready to Begin Your Journey?
If you are ready for wellness, hope, and recovery, please call us at 269-467-1000 and a member of our Access Team will be honored to assist you! All calls are private, confidential, and are the starting point to have us learn about your needs, concerns, and the individualized help you are seeking. At Pivotal, our goal is timely access to services upon referral, individual request, or discharge from inpatient care. We proudly serve all ages with mild to moderate behavior health concerns, not just those with severe or persistent needs, including individuals with private health insurance.
Eligibility
Services are available to individuals who:
- Live in St. Joseph County.
- Have a serious mental illness, developmental disability, serious emotional disturbance, substance use disorder and/or co-occurring substance use disorder.
- Have Medicaid. (*If you do not have insurance, we can provide you with a Medicaid application. If you do not have insurance and meet all other eligibility criteria, you may be placed on a waiting list.)
- Demonstrate medical need for services.
Medical Necessity
Services authorized for treatment of a behavioral health and/or co-occurring substance use disorder concern must be medically necessary. You will participate in an assessment of your needs to identify the type of services you might be eligible to receive. Medical necessity also means that the amount (how much of a service you get), scope (who provides the service and how), and duration (how long the service will last) of your services are enough to meet your needs. Medicaid recipients are guaranteed to receive services that are medically necessary. For people who have no insurance, there is no guarantee they will get services if there is not the money to provide those services, and they may be placed on a waiting list.
If you have Medicaid:
- You are eligible for a specific set of services based on medical necessity.
- You cannot be put on a waiting list for a service considered “medically necessary” unless you are in agreement.
If you do not have Medicaid (General Fund):
- The list of services is not as large as it is for those who have Medicaid.
- You can be put on a waiting list for mental health services if there is not enough funding to provide the service and you do not qualify for Medicaid.
Referrals
We accept referrals from a variety of sources, including primary care and other healthcare providers, law enforcement, attorneys, Department of Health and Humans Services (DHHS), local shelters (Keystone Place and Domestic and Sexual Abuse Services (DASAS)), schools, employers, etc. Clients may also be self-referred or referred by family members.
Non-Discrimination
Pivotal will not discriminate in the provision of health care services to an individual:
• Because the individual is unable to pay for health care services;
• Because payment for those services would be made under Medicare, Medicaid, or the Children's Health Insurance Program (CHIP); or
• Based upon the individual's race, color, sex, age, national origin, disability, religion, gender identity or sexual orientation.
Payment for Services
If you are enrolled in Medicaid and meet criteria for services, the total cost of your authorized mental health or substance abuse treatment will be covered (no fees will be charged to you.)
Otherwise, services are based on eligibility and payment is based on what you can afford. We will assess a person’s ability to pay for services and establish a fair fee. No individual will be denied access to services due to inability to pay; and there is a discount/sliding fee schedule available based on family size and income.
To determine your fee, a review of requested documents along with information you provide will be reviewed. In general, you’ll be asked to provide information about any sources of income or health insurance that may cover services. All financial information will be held in the strictest confidence. Once a fee has been determined, you also can ask for a review of your determined fee if you do not agree with the amount you are asked to pay.
Make sure that you inform us of all the insurances you are covered by, as well as any changes to your insurance. If you fail to provide insurance information you may be at risk of being charged services that might otherwise be covered.
Discount/Sliding Fee Schedule
Pivotal fees are based on our cost to provide services. Your part of that fee is set up based upon your ability to pay using a sliding fee scale. No individual will be denied access to services due to inability to pay. The discount/sliding fee schedule is available based on family size and income.
Have An Emergency?
Mental Health Emergency
If a person is experiencing symptoms and behaviors that can reasonably be expected in the near future to lead them to harm themselves or others; and/or because of their inability to meet their basic needs they are at risk of harm; and/or the person’s judgment is so impaired that they are unable to understand the need for treatment and that their condition is expected to result in harm to themselves or others in the near future, you (or they) have the right to receive emergency services at any time, 24 hours a day, 7 days a week, without prior authorization for payment of care.
If you have a mental health emergency, you should seek help right away. At any time during the day or night you can call 1-800-622-3967 and speak to a crisis worker. You can also call 911 or go to your nearest hospital emergency room.
Out-of-County Mental Health Emergency
If you have Medicaid, carry your card with you at all times. You are covered for emergency mental health services anywhere within the State of Michigan.
If you have a mental health emergency while you are outside of the county where you receive services, you should contact the County Mental Health (CMH) office where you are at during the time of the emergency, or go the nearest hospital emergency room.
The County Mental Health (CMH) office where you are during the emergency will contact us to arrange for your care.