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The following information applies to services on or after January 1, 2010.
Please note: As of January 1, 2010, there is no visit or dollar limit on mental health services. However, inpatient mental health services do require preauthorization. These services are paid based on the network status of the provider.
TIP: If you see a non-network provider for mental health services, please note that:
- Only the provider types listed under "Approved Provider Types for Mental Health Services" are covered. The plan doesn't pay for services by provider types not listed there.
- Covered services are paid at the non-network rate.
The plan covers mental health services for treatment of neuropsychiatric, mental, and personality disorders, including eating disorders. Marriage or family counseling is not covered.
The following services must be preauthorized by the plan:
- Inpatient stays
- Intensive outpatient treatment
- Partial hospitalization
- Residential treatment settings
Inpatient
Services are considered "inpatient" when your stay at a facility is expected to be longer than 24 hours. You pay a $200 per day copay for inpatient facility services, up to $600 per calendar year. This copay covers charges by the facility. However, services by professional providers (for example, doctors) may be billed separately from the facility. The plan pays for these services according to the network status of the provider, unless your condition is a medical emergency.
ALERT! All inpatient services for mental health treatment must be preauthorized by the plan. Inpatient services that are not preauthorized may not be covered.
Outpatient
Outpatient mental health services are covered as any other medical service. The plan pays based on the network status (network or non-network) of the provider. However, services by some provider types aren't covered or are limited; see "Approved Provider Types for Mental Health Services" below. See this list for mental health services that must be preauthorized by the plan.
Approved Provider Types for Mental Health Services
Mental health treatment must be provided by one of the following provider types:
- Licensed community mental health agency
- Advanced registered nurse practitioner (ARNP), licensed
- Licensed physician
- Licensed psychologist
- Licensed Master of Social Work, Licensed Mental Health Counselor, or Licensed Marriage and Family Therapist
- Licensed hospital
Limitations on Some Provider Types
The plan covers services of a licensed marriage and family counselor only when provided to treat an individual enrollee's neuropsychiatric, mental, or personality disorders. Marriage or family counseling is not covered.
The plan does not cover services provided by registered counselors. (Only licensed mental health care providers are covered. A registered counselor is not the same as a licensed counselor.)
Services by non-PhD psychologists are covered only when the provider is employed by and delivers services within a licensed community mental health agency and the agency bills for the services.
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