RTC
What is RTC
Residential Treatment Center
Are family counseling services covered?
No, Marital, family, educational, or other counseling or training services are not covered
Does deductible apply for professional service for preferred.
Preferred: $25 copayment for the visit (no deductible)
Talk point --- Non-participating: 35% of the Plan allowance (deductible applies), plus the difference between our allowance and the billed amount
Who has to agree to the treatment plan
Case Manager
Member
Provider (RTC)
Guidance counselor services
No, Services performed or billed by schools, halfway houses, group homes are not covered
Are tele health services provided
yes 10 preferred and 15 basic
Is precert required
Yes
Exercise on horseback
Hippotherapy/equine therapy (exercise on horseback) is not a covered service
What is the penalty for no pre certification for hospital stay
$500
What is covered under RTC
We cover inpatient care provided and billed by an RTC for members enrolled and participating in case management through the Local Plan, when the care is medically necessary for treatment of a medical, mental health, and/or substance use disorder:
Is Group psychotherapy covered
yes such as AA or family counseling if there is a medical diagnosis
Is the member responsible for deductible/co-payment on Inpatient stays
Preferred facilities: $350 per admission copayment for unlimited days (no deductible)
Non-member facilities: 35% of the Plan allowance for unlimited days (no deductible), and any remaining balance after our payment
What facilities are not covered under RTC
RTC benefits are not available for facilities licensed as a skilled nursing facility, group home, halfway house, or similar type facility
When are benefits payable?
They are payable only when we determine they are medically necessary.
What is the co-payment or coinsurance for Residential Treatment preferred
$350 per admission copayment for unlimited days (no deductible) or
Basic $175 per day copayment up to $875 per admission for unlimited days