Common use of Mental Health and Substance Abuse Treatment Clause in Contracts

Mental Health and Substance Abuse Treatment. Non-Network (a) Inpatient Mental Health Treatment (general acute or psychiatric hospital or clinic including inpatient and partial hospitalization, intensive outpatient and day treatment programs and 23 hour extended and 72 hour crisis beds) 1. Medically necessary inpatient mental health care coverage at a non-network facility is available. The Plan pays up to 80 percent of the allowable amount less a $200 copayment. A new $200 copayment is required if the admission occurs more than 90 days after the previous admission. All elective admissions must be pre-certified. If pre- certification of an elective admission does not occur, the Plan pays up to 50 percent of the network allowance less the $200 copayment. (b) Inpatient Mental Health Treatment (residential treatment center, group home for halfway house) 1. Not a covered benefit.

Mental Health and Substance Abuse Treatment. Non-Network (a) Inpatient Mental Health Treatment (general acute or psychiatric hospital or clinic including inpatient and partial hospitalization, intensive outpatient and day treatment programs and 23 hour extended and 72 hour crisis beds) 1. Medically necessary inpatient mental health care coverage at a non-network facility is available. The Plan pays up to 80 percent of the allowable amount less a $200 copayment. A new $200 copayment is required if the admission occurs more than 90 days after the previous admission. All elective admissions must be pre-certified. If pre- pre-certification of an elective admission does not occur, the Plan pays up to 50 percent of the network allowance less the $200 copayment. (b) Inpatient Mental Health Treatment (residential treatment center, group home for halfway house) 1. Not a covered benefit.