2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 90
 
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 22.

You Pay
Preferred facilities: 30% of the Plan allowance

Non-preferred (Member/Non-member) facilities: You pay all charges
 
Benefit Description
Not covered:
  • Marital, family, educational, or other counseling or training services
     
  • Services performed by a non-covered 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 79 and 89
     
  • 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 his or her 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)

You Pay
All charges