2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Residential Treatment Center
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Residential Treatment Center
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Residential Treatment Center
Inpatient Residential Treatment Center:
Precertification prior to admission is required.
We cover inpatient care provided and billed by an RTC when the care is medically necessary for the treatment of a medical, mental health, and/or substance use disorder:
Notes:
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred facilities (Member/Non-member): You pay all charges
Benefit Description
Residential Treatment Center
Inpatient Residential Treatment Center:
Precertification prior to admission is required.
We cover inpatient care provided and billed by an RTC when the care is medically necessary for the treatment of a medical, mental health, and/or substance use disorder:
- Room and board, such as semiprivate room, nursing care, meals, special diets, ancillary charges, and covered therapy services when billed by the facility.
Notes:
- For inpatient care received overseas, refer to Section 5(i).
- For outpatient residential treatment center services, see Section 5(c).
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred facilities (Member/Non-member): You pay all charges
Benefit Description
Not covered services, such as:
Note: Residential treatment center benefits are not available for facilities licensed as skilled nursing facilities, group home, halfway house or similar type facilities.
You Pay
All charges
Not covered services, such as:
- Biofeedback
- Custodial or long-term care (see Definitions)
- Domiciliary care provided because care in the home is not available or is unsuitable
- Educational therapy or educational classes
- Equine/hippotherapy provided during the approved stay
- Recreational therapy
- Respite care
- Outdoor residential programs
- Outward Bound programs
- Personal comfort items, such as guest meals and beds, phone, television, beauty and barber service
- Services provided outside of the provider’s licensure/scope of practice
Note: Residential treatment center benefits are not available for facilities licensed as skilled nursing facilities, group home, halfway house or similar type facilities.
You Pay
All charges