Required Approval for Behavioral Health Care
Approval for behavioral health services may be secured
through the MAP on a completely confidential basis.
Either you or your referring physician may call the MAP.
When you receive approval for care through the MAP,
services will always be In-Network.
If you are admitted to a hospital or other facility without
getting advance approval from the ComPsych Behavioral
Health Manager, you will have to pay the first $250 of
charges as a non-certification penalty for the admission,
and the admission will be considered Out-of-Network.
Out-of-Network behavioral health facility admissions are
paid at 50% in the Premier Plan only; they are not covered
in the Basic and Core Plans. In addition, if the admission
is determined not to have been medically necessary, all
charges will be excluded from coverage. Outpatient care
should be discussed with and approved by the ComPsych
Behavioral Health Manager.
You are responsible to insure that your provider has
obtained approval for your treatment. If your outpatient
visits, even if rendered by a ComPsych provider, are determined
by the ComPsych Behavioral Health Manager to be
inappropriate for the treatment of a particular ailment
based upon professional standards and protocols in the
geographic area in which the treatment is rendered, or they
are found to be experimental or not medically necessary,
the outpatient visits will not be covered. Advanced approval
is not required for treatment under the MILA
Medicare Wrap-Around Plan because Medicare administers
these benefits.
