What is Covered — Mental Health and Substance Abuse Benefits

Regardless of whether a participant uses a network or out-of-network provider, he or she will receive benefits only if the treatment received is considered "medically necessary" by CBH. "Medically necessary" means mental health, alcoholism or drug dependency treatment services which are:

• Adequate and essential for the evaluation and/or treatment of a disease, condition or illness;
• Can reasonably be expected to improve an individual's condition or level of functioning; and
• Are in keeping with national standards of mental health professional practice (psychiatry, clinical psychology, psychiatric social work, psychiatric nursing), as defined by standard clinical references, valid empirical references for efficacy of psychotherapy(ies) and national professional standards, and promulgated by national mental health professional associations and federal agencies utilizing professional consensus development and scientific data.