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Covered Services

Covered behavioral services are specific to each health plan's requirements. General behavioral care services include emergency care, inpatient care, individual psychotherapy, group psychotherapy, couples and family therapy, psychiatric medication management. Health plans may also cover partial hospitalization, detoxification, chemical dependency rehabilitation, ECT.

Services typically excluded from mental health and substance abuse coverage are: custodial care; treatment of mental retardation; weight reduction; acupuncture and acupressure; cognitive therapy for medical conditions; all services provided by primary care physicians; laboratory tests and radiological services; transportation needed for medical reasons; biofeedback for medical conditions; methadone maintenance; psychological testing requested by school system or to fulfill legal evaluation, or required by an employer or for vocational) or to assess mental health and developmental disabilities; neuropsychological testing; treatment for military related disorders covered by government facilities.

Services for members with co-morbid medical and behavioral diagnoses are determined based on place of service. The primary diagnosis that is causing the patient to remain in the current setting represents a general principle for determining behavioral health vs. medical benefit status. These cases are generally co-managed by the medical management team and the behavioral care team.

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