Mental Health and Substance Use Disorder Benefits. The coverage described below is designed to comply with requirements under the Xxxx Xxxxxxxxx-Xxxx Xxxxxxxx Mental Health Parity and Addiction Equity Act of 2008. Mental health services will be provided on an inpatient and outpatient basis and include mental health conditions. These conditions affect the individual’s ability to cope with the requirements of daily living. If you need mental health and/or substance use disorder treatment, you may choose any provider participating in our behavioral health network. You can search for network behavioral health providers by using the “Find a Provider” function at XxxxxxxxxxXxxxxxxx.xxx or by calling Member Services at 1-855-745-5507 (TTY 1-844- 517-3431). Deductible amounts, copayment or coinsurance amounts and treatment limits for covered mental health and substance use disorder benefits will be applied in the same manner as physical health service benefits. Covered services for mental health and substance use disorder are included on a non-discriminatory basis for all members for the diagnosis and medically necessary treatment of mental, emotional, or substance use disorders as defined in this policy. When making coverage determinations, our behavioral health and substance use disorder utilization management staff employ established level of care guidelines and medical necessity criteria that are based on currently accepted standards of practice and take into account legal and regulatory requirements. They utilize Change Healthcare’s InterQual criteria for mental health determinations and American Society of Addiction Medicine (ASAM) criteria for substance use disorder determinations. Services should always be provided in the least restrictive clinically appropriate setting. Any determination that requested services are not medically necessary will be made by a qualified licensed mental health professional. Covered Inpatient and Outpatient mental health and/or substance use disorder services are as follows:
Appears in 4 contracts
Samples: Evidence of Coverage, Evidence of Coverage, Evidence of Coverage
Mental Health and Substance Use Disorder Benefits. The coverage described below is designed to comply with requirements under the Xxxx Xxxxxxxxx-Xxxx Xxxxxxxx Mental Health Parity and Addiction Equity Act of 2008. Mental health services will be provided on an inpatient and outpatient basis and include mental health conditions. These conditions affect the individual’s ability to cope with the requirements of daily living. If you need mental health and/or substance use disorder treatment, you may choose any provider participating in our behavioral health network. You can search for network behavioral health providers by using the “Find a Provider” function at XxxxxxxxxxXxxxxxxx.xxx or by calling Member Services at 1-855-745-5507 (TTY 1-844- 517-3431). Deductible amounts, copayment or coinsurance amounts and treatment limits for covered mental health and substance use disorder benefits will be applied in the same manner as physical health service benefits. Covered services for mental health and substance use disorder are included on a non-discriminatory non‐discriminatory basis for all members for the diagnosis and medically necessary treatment of mental, emotional, or substance use disorders as defined in this policy. When making coverage determinations, our behavioral health and substance use disorder utilization management staff employ established level of care guidelines and medical necessity criteria that are based on currently accepted standards of practice and take into account legal and regulatory requirements. They utilize Change Healthcare’s InterQual criteria for mental health determinations and American Society of Addiction Medicine (ASAM) criteria for substance use disorder determinations. Services should always be provided in the least restrictive clinically appropriate setting. Any determination that requested services are not medically necessary will be made by a qualified licensed mental health professional. Covered Inpatient and Outpatient mental health and/or substance use disorder services are as follows:
Appears in 1 contract
Samples: Evidence of Coverage
