Inpatient Mental Health and Substance Use Disorder Services. Benefits are provided when the Member is admitted under the care of a Contracting Physician as an inpatient in a hospital or other CareFirst BlueChoice-approved health care facility for treatment of Mental Illness, Emotional Disorders, and Substance Use Disorder as follows: SAMPLE
A. Hospital benefits will be provided, as described in Section 5, Inpatient Hospital Services, of this Description of Covered Services, on the same basis as a medical (non-Mental Health or Substance Use Disorder) admission.
B. Contracting Provider services provided to a hospitalized Member, including physician visits, charges for intensive care, or consultative services, only if CareFirst BlueChoice determines that the Contracting Provider rendered services to the Member and that such services were medically required to diagnose or treat the Member’s condition. The following benefits apply if the Member is an inpatient in a hospital covered under inpatient hospitalization benefits following CareFirst BlueChoice certification of the need and continued appropriateness of such services in accordance with CareFirst BlueChoice utilization management requirements:
1. Contracting Provider visits during the Member’s hospital stay;
2. Intensive care that requires a Contracting Provider’s attendance;
3. Consultation by another Contracting Provider when additional skilled care is required because of the complexity of the Member’s condition; and
C. Benefits are available for diagnosis and treatment for Substance Use Disorder, including inpatient detoxification and rehabilitation services in an acute care hospital or Qualified Treatment Facility. Members must meet the applicable criteria for acceptance into, and continued participation in, treatment facilities/programs, as determined by CareFirst BlueChoice.
D. Electroconvulsive therapy.
Inpatient Mental Health and Substance Use Disorder Services. SAMPLE Benefits are provided when the Member is admitted as an inpatient in a hospital or other CareFirst- approved health care facility for treatment of Mental Illness, Emotional Disorders, and Substance Use Disorder as follows:
A. Hospital benefits will be provided, as described in Section 5, Inpatient Hospital Services, of this Description of Covered Services, on the same basis as a medical (non-Mental Health or Substance Use Disorder) admission.
B. Services provided to a hospitalized Member, including physician visits, charges for intensive care, or consultative services, only if CareFirst determines that the health care provider rendered services to the Member and that such services were medically required to diagnose or treat the Member’s condition. The following benefits apply if the Member is an inpatient in a hospital covered under inpatient hospitalization benefits following CareFirst certification of the need and continued appropriateness of such services in accordance with CareFirst utilization management requirements:
1. Health care provider visits during the Member’s hospital stay;
2. Intensive care that requires a health care provider’s attendance;
3. Consultation by another health care provider when additional skilled care is required because of the complexity of the Member’s condition; and
C. Benefits are available for diagnosis and treatment for Substance Use Disorder, including inpatient detoxification and rehabilitation services in an acute care hospital or Qualified Treatment Facility. Members must meet the applicable criteria for acceptance into, and continued participation in, treatment facilities/programs, as determined by CareFirst.
D. Electroconvulsive therapy.
