Exclusions and Limitations for Outpatient Sample Clauses

Exclusions and Limitations for Outpatient and Inpatient Mental Health Treatment Services. Covered Services are limited to those authorized by GHC's Medical Director, or his/her designee, for covered clinical conditions for which the reduction or removal of acute clinical symptoms or stabilization can be expected given the most clinically appropriate level of mental health care intervention. Partial hospitalization programs are covered only under subsection K.2. (Inpatient Services). Excluded: learning, communication and motor skills disorders; mental retardation; academic or career counseling; sexual and identity disorders; and personal growth or relationship enhancement. Also excluded: assessment and treatment services that are primarily vocational and academic; court-ordered or forensic treatment, including reports and summaries, not considered Medically Necessary; work or school ordered assessment and treatment not considered Medically Necessary; counseling for overeating; nicotine related disorders; relationship counseling or phase of life problems (V code only diagnoses); and custodial care. Any other services not specifically listed as covered in this section. All other provisions, exclusions and limitations under the Agreement also apply.
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Related to Exclusions and Limitations for Outpatient

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