Inpatient Mental Health and Substance Use Disorder Services Sample Clauses

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.
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Inpatient Mental Health and Substance Use Disorder Services. 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: 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. 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.
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Related to Inpatient Mental Health and Substance Use Disorder Services

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient Hospital Unlimited days at a general hospital or a specialty hospital including withdrawal management (detoxification) per plan year. Residential Treatment Facility Unlimited days for residential mental health and substance use disorder services per plan year. Notification of admission may be required. 0% - After deductible Not Covered Outpatient or intermediate care services - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Notification of services may be required. 0% - After deductible Not Covered Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible Not Covered Medication-assisted treatment - when rendered by a mental health or substance use disorder provider. 0% - After deductible Not Covered Methadone maintenance treatment. 0% - After deductible Not Covered Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per covered episode. 0% - After deductible Not Covered

  • Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services. This plan covers dental care for members until the last day of the month in which they turn nineteen (19). This plan covers services only if they meet all of the following requirements: • listed as a covered dental care service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered dental care service under this plan. • dentally necessary, consistent with our dental policies and related guidelines at the time the services are provided. • not listed in Exclusions section. • received while a member is enrolled in the plan. • consistent with applicable state or federal law. • services are provided by a network provider.

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.