55 Mental Health and Substance Use Disorder Services Covered Services include the following: • Inpatient Services in a Hospital or any Facility that must be covered by law. Inpatient benefits include psychotherapy, psychological testing, electroconvulsive therapy, and detoxification. • Residential Treatment in a licensed Residential Treatment Center that offers individualized and intensive treatment and includes: • Observation and assessment by a physician weekly or more often, • Rehabilitation and therapy. • Outpatient Services including office visits, therapy and treatment, Partial Hospitalization/Day Treatment Programs, and Intensive Outpatient Programs and Intensive In - Home Behavioral Health Services. • Virtual Visits as described under the “Virtual Visits (Telemedicine / Telehealth Visits)” section. Examples of Providers from whom you can receive Covered Services include: • Psychiatrist, • Psychologist, • Neuropsychologist, • Licensed clinical social worker (L.C.S.W.), • Mental health clinical nurse specialist, • Licensed marriage and family therapist (L.M.F.T.), • License Mental Health Counselor (L.M.H.C.), • Licensed Addiction Counselor or Clinical Addiction Counselor, or • Any agency licensed to give these services, when they must be covered by law . Occupational Therapy Please see “Therapy Services” later in this section. Office and Home Visits Covered Services include: Office Visits for medical care (including second surgical opinions) to examine, diagnose, and treat an illness or injury. Home Visits for medical care to examine, diagnose, and treat an illness or injury. Please note that Doctor and Primary Care Provider visits in the home are different than the “Home Health Care Services” benefit described earlier in this Booklet. Consultations between your Primary Care Physician and a Specialist, when approved by the Plan. Retail Health Clinic Care for limited basic health care services to Members on a “walk - in” basis. These clinics are normally found in major pharmacies or retail stores. Health care services are typically given by Physician’s Assistants or Nurse Practitioners. Services are limite d to routine care and treatment of common illnesses for adults and children.
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