Medical necessity criteria carefirst residential psychiatric

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This insurer requires programs to pass certain standards of clinical excellence in order to receive coverage. Depending on your plan, you may be eligible for reduced rate drug and alcohol detox services. For members who receive addiction-only services at a preferred treatment center, some CareFirst plans will waive cost sharing requirements. This removes charges associated with deductibles, coinsurance, and copayments.

For more information, please read on or call us to verify your coverage. Those with CareFirst insurance gain access to a preferred network of behavioral healthcare providers and addiction treatment centers.

Beach House is one such treatment provider. Depending on your specific plan, you may receive significant coverage for:. Costs for eligible addiction treatment services may be waived depending on the extent of your benefits.

We understand how stressful it can be to navigate the world of insurance. To obtain coverage for some behavioral health services through Blue Cross Blue Shield of Mississippi, healthcare providers may need to obtain Pre-certification from the health plan. The policy notes that Intermediate Care Services may include individual, family, and group therapy; medication consultation and management; case management coordination; emergency crisis evaluation available 24 hours a day, 7 days per week; and psychiatric assessment.

The following policies may be relevant to treatment of eating disorders, including bulimia nervosa:. Blue Cross Blue Shield of Wyoming has no publicly available coverage policies that apply to behavioral health, eating disorders, or bulimia nervosa or that define appropriate levels of care for these conditions.

Blue Shield of California has no publicly available coverage policies that apply to behavioral health, eating disorders, or bulimia nervosa or that define appropriate levels of care for these conditions. CareFirst contracts with Magellan Healthcare to provide behavioral health services. CareFirst has no publicly available policy specific to treatment of bulimia nervosa or eating disorders. Cigna levels of care for eating disorders and specifically for bulimia nervosa include the following: Acute Inpatient Treatment, Partial Hospital Treatment, Residential Treatment, Intensive Outpatient Treatment, and Outpatient Treatment.

Empire also refers to three other policies that may be relevant in individual cases, depending on the diagnosis, whether a dual diagnosis is part of the patient history, and other factors. The health plan does have a Specialty Program for Coordinated Care for the Treatment of Eating Disorders , which features dedicated staff who arrange for an appropriate care level. Excellus has two publicly available coverage policies on its website that address treatments for eating disorders.

Beacon provides the following levels of care for eating disorders: Inpatient, Partial Hospitalization, Residential Treatment, Intensive Outpatient, and Outpatient care. Case management and Eating Disorder Care Team specialty programs may be available. The insurers may require preauthorization for all Inpatient, Residential Treatment, Partial Hospitalization admissions, and Intensive Outpatient programs.

Health Net contracts with Managed Health Network to provide behavioral health benefits. The insurer does not have publicly available coverage policies specific for bulimia nervosa or eating disorders. HealthPartners is an integrated health plan and delivery system that may cover treatment for eating disorders, including bulimia nervosa, that meet the DSM-5 criteria for an eating disorder, based on language in specific health plan documents.

Health Partners requires prior authorization for all residential services, including those for the treatment of eating disorders. A behavioral health coordinator and a board-certified psychiatrist must also review all eating disorder assessments and relevant clinical information before admission for Residential Care. Highmark plans generally do not specify levels of care available for eating disorders as some other health plans might.

The Highmark Commercial Medical Policy for Delaware, Mental Illness Coverage, V , states that the Delaware Mental Health Parity mandate addresses behavioral health coverage in individual and small group health plans under 51 employees that are not subject to federal Mental Health Parity law. According to the Delaware mandate, health plans delivered or issued for delivery in Delaware must provide coverage for the diagnosis and treatment of serious mental illness, including bulimia and anorexia, and drug or alcohol dependency, based on the most recent Diagnostic and Statistical Manual of Mental Disorders criteria.

Highmark has related policies for medical nutrition that may be applicable to bulimia and eating disorders. The company provides a brief outline of its Behavioral Health Benefits on its website but does not specify available levels of care or covered treatments specifically for eating disorders or bulimia.

Humana Behavioral Health states that its care managers will authorize the appropriate levels of care. Depending on language within particular behavioral health benefit plans, available behavioral healthcare may be limited to providers in the Humana Behavioral Health network. Independence Blue Cross has no publicly available coverage policies that apply to behavioral health, eating disorders, or bulimia nervosa or that define treatments or appropriate levels of care for these conditions.

Kaiser Permanente, an integrated healthcare delivery system and health plan, does not make its coverage policies public. Its website, however, states that it provides covered members with assessment, treatment, and support for a variety of mental and emotional health conditions, including eating disorders. Various regions of the Kaiser network offer classes for beneficiaries and their families about eating disorders and treatment.

The network also provides information about accessing behavioral health services in each of its nine geographic regions, with phone numbers to call for eating disorder services in each network area.

These resources can be found on the Behavioral Health Services section of the Kaiser Permanente website. Magellan Health Services provides a full spectrum of managed mental health and substance abuse services.

The Magellan Clinical Practice Guideline: Eating Disorders outlines its clinical strategy and goals for treatment of patients with bulimia nervosa and other eating disorders. All levels of care require a DSM-5 diagnosis. In its Coverage Determination Guideline: Treatment of Bulimia Nervosa, Guideline Number: BHCDG , Optum lists first-line treatments for bulimia to include nutritional rehabilitation, psychotherapy, and pharmacotherapy, as well as monitoring patients for medical complications.

Services for bulimia nervosa treatment depend on the exact plan a member has purchased. New Directions Behavioral Health NDBH is a managed care behavioral health plan that covers acute inpatient hospitalization, partial hospitalization, residential treatment, outpatient treatment, and intensive outpatient treatment for members with an eating disorder, including bulimia nervosa.

Premera Blue Cross operates in Alaska and Washington state. Premera does not have a publicly available coverage policy relevant to eating disorders or bulimia nervosa. Premera partners with Quartet Health, Inc. Regence currently lists no publicly available general coverage policies addressing eating disorders or bulimia on its website.

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