2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Outpatient Hospital or Other Covered Facility
Section 5(e). Mental Health and Substance Use Disorder Benefits
Outpatient Hospital or Other Covered Facility
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Outpatient Hospital or Other Covered Facility
Outpatient services provided and billed by a covered facility
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required. Failure to obtain prior approval will result in a $100.00 penalty. See page 19.
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges
Benefit Description
Outpatient Hospital or Other Covered Facility
Outpatient services provided and billed by a covered facility
- Diagnostic tests
- Group psychotherapy
- Individual psychotherapy
- Intensive outpatient treatment
- Partial hospitalization
- Pharmacologic (medication) management
- Psychological testing
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required. Failure to obtain prior approval will result in a $100.00 penalty. See page 19.
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Marital, family, educational, or other counseling or training services
- Services performed by a noncovered provider
- Testing for and treatment of learning disabilities and intellectual disability
- Inpatient services performed or billed by residential treatment centers, except as described on pages 76 and 87
- Services performed or billed by schools, halfway houses, group homes or members of their staffs
Note: We cover professional services as described on page 16 when they are provided and billed by a covered professional provider acting within the scope of their license.
- Psychoanalysis or psychotherapy credited toward earning a degree or furtherance of education or training regardless of diagnosis or symptoms that may be present
- Services performed or billed by residential therapeutic camps (e.g., wilderness camps, Outward Bound, etc.)
- Light boxes
- Custodial or long-term care (see Definitions)
- Costs associated with enabling or maintaining providers’ telehealth (telemedicine) technologies, non-interactive telecommunication such as email communications, or asynchronous store-and-forward telehealth services
You Pay
All charges