Common use of Substance Abuse Benefits Clause in Contracts

Substance Abuse Benefits. A Member is covered for the following services as authorized and provided by Participating Behavioral Health Providers: • Outpatient care benefits are covered for Detoxification. Benefits include diagnosis, medical treatment and medical referral services (including referral services for appropriate ancillary services) by the Member’s PCP for the abuse of or addiction to alcohol or drugs. Member is entitled to outpatient visits to a Participating Behavioral Health Provider upon Referral by the PCP for diagnostic, medical or therapeutic Substance Abuse Rehabilitation services. Coverage is subject to the limits, if any, shown on the Schedule of Benefits. • Inpatient care benefits are covered for Detoxification. Benefits include medical treatment and referral services for Substance Abuse or addiction. The following services shall be covered under inpatient treatment: lodging and dietary services; Physicians, psychologist, nurse, certified addictions counselor and trained staff services; diagnostic x-ray; psychiatric, psychological and medical laboratory testing; and drugs, medicines, equipment use and supplies. Member is entitled to medical, nursing, counseling or therapeutic Substance Abuse Rehabilitation services in an inpatient, Hospital or non-hospital Residential Treatment Facility, appropriately licensed by the Department of Health, upon referral by the Member’s Participating Behavioral Health Provider for alcohol or drug abuse or dependency. Coverage is subject to the limits, if any, shown on the Schedule of Benefits.