Care Management

Scripps Health Plan’s care management services are designed to provide a collaborative process that assesses, plans, implements, coordinates, and evaluates options and services to meet your individual health and social needs. These services focus on identifying member health needs, care coordination, disease management, complex and chronic care management and providing medically appropriate care in a coordinated manner. Our services are voluntary and are provided at no additional cost to you.  

The care manager works directly with you and your family/caregiver(s), and your care team to develop an Individualized Care Plan (ICP) that is focused on increasing access to resources and services that support your health needs. 

Our care management services are designed to complement the care delivered by your doctors and other health care providers and is not to replace the treatment, advice or recommendations of your health care providers.  

Did you know that anyone can make a referral to our Care Management services? Referrals can be made via:

• Email: shpsccmreferrals@scrippshealth.org
• Voicemail: 888-399-5678
• Fax: (858) 260-5834
• CM Referral Form (PDF, 58 KB)

Disease Management Programs

Scripps Health Plan also offers additional information and guidelines on managing certain diseases or conditions.

You may request condition-specific educational materials that have been created based on best-practice guidelines approved by our medical management team. 

Our nurses and your provider will offer additional support, helping you to understand what your condition means to your everyday life. We can also provide contact information for community resources that will help educate you and your family on how to stay on top of your condition and manage your health. It’s all part of our commitment to helping you feel your best.

The materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

Behavioral Health Services 

Your mental and emotional wellbeing is just as important as your physical health.

We partner with Evernorth Behavioral Health of California, Inc. to deliver all mental health and substance abuse services through a unique network of mental health providers. Members can access this care without a referral. 

It is important to note that crisis intervention and stabilization are considered emergency services and do not require prior authorization.

Scripps Health Plan covers the following behavioral health services:

• Crisis services
• Inpatient psychiatric hospital services
• Services from licensed behavioral health professionals
• Alcohol and substance abuse treatment
• Maternal mental health

Care is coordinated with your primary care provider (PCP) consistent with professionally recognized evidence-based standards of practice across the health care network.

To see if your current provider is available, visit well.evernorth.com. 

You may also call 888-736-7009, TTY: 711 for the hearing and speech impaired, 24 hours a day, 7 days a week, to speak to an Evernorth Behavioral Health representative.

Doula Services

Scripps Health Plan offers doula services as part of our efforts to improve access to pregnancy care. Our goal is a healthy outcome for parent and baby. 

What is a doula?

Doulas are birth workers who provide help to birthing persons through pregnancy, labor, and postpartum. They can also help in the event of miscarriage, stillbirth, or abortion. Doula services are in addition to medical care from your obstetrician or midwife.

During pregnancy

During pregnancy, doulas can connect you with community resources and help you create a birth plan. They can also help you with birthing techniques.

During labor and delivery

Your doula is present during childbirth for physical and emotional support. A doula is your advocate. They help you talk with hospital staff and make sure your wishes are known. They also provide nonmedical help with labor.

After pregnancy

A doula can help you with breastfeeding, healing, and recovery. They can offer advice on infant care for up to 12 months after the end of pregnancy. A doula also provides support for a stillbirth, miscarriage, or abortion.

Your covered services

With a referral, you are eligible for the following doula services:

• One (1) initial visit with your doula.
• Up to eight (8) additional visits; these can be a combination of prenatal and postpartum visits.
• Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage.
• Up to two (2) three-hour postpartum visits.

Members can get doula services up to 12 months after the end of pregnancy. 

How to get a referral for doula services

Please reach out to your primary care doctor for a referral, or call our Care Management team at 888-399-5678, 8 am to 5 pm Pacific time, Monday through Friday.