What is Not Covered — Mental Health and Substance Abuse Benefits

No payment will be made by CBH for the following care, services or supplies:

• Educational rehabilitation or treatment of learning disabilities, regardless of the setting in which such services are provided;
• Educational/academic testing and services;
• Residential Coverage for Wilderness Programs or Military Schools, unless licensed by JCAHO (or an appropriate state licensing board), has 24-hour nursing, and an onsite psychiatrist;
• Residential facilities, unless licensed by JCAHO (or an appropriate state licensing board), has 24-hour nursing, and an onsite psychiatrist;
• Custodial care;
• Treatment for personal or professional growth development, or training or professional certification;
• Evaluations, consultations or therapy for educational or professional training or for investigational purposes relating to employment;
• Therapies which do not meet national standards for mental health professional practice, including but not limited to Erhard/The Forum, primal therapy, rolfing, sensitivity training, bioenergetic therapy or crystal healing therapy;
• Experimental or investigational therapies;
• Court-ordered psychiatric or substance abuse treatment, except when certified by CBH as medically necessary;
• Psychological testing, except when precertified as medically necessary by CBH;
• Services, supplies or treatment that are covered for benefits under the medical portion of this plan;
• Prescription drugs;
• Private duty nursing, except when precertified by CBH as medically necessary;
• Treatment of congenital and/or organic disorders, except for the associated treatable and acute behavioral manifestations;
• Aversion therapy;
• Treatment for codependency;
• Non-abstinence-based or nutritionally-based treatment for substance abuse;
• Treatment or consultations provided via telephone;
• Services, treatment or supplies:
  • Provided as a result of Worker's Compensation laws or similar legislation;
  • Obtained through, or required by, any governmental agency or program whether federal, state or any subdivision thereof (exclusive of Medicaid/Medi-Cal); or
  • Caused by the conduct or omission of a third-party for which the Member has a claim for damages or relief, unless the participant provides CBH with a lien against such claim for damages or relief in a form and manner satisfactory to CBH;
• Treatment or consultations provided by the member's parents, siblings, children or current or former spouse or domiciliary partner;
• Sexual therapy programs;
• Remedial education beyond evaluation and diagnosis of learning disabilities, education rehabilitation, academic education, and educational therapy for learning disabilities;
• Couples therapy, except when certified as a medically necessary part of the treatment plan of a spouse covered by the plan, with a DSM-IV Mental Disorder;
• Marriage counseling;
• Conditions resulting from:
  • An act of war (declared or undeclared);
  • Insurrection; or
  • Atomic explosion or other release of nuclear energy under any conditions (except when used solely as medical treatment);
• Treatment for caffeine or nicotine intoxication, withdrawal or dependence; or
• Counseling/therapy related to a change of sex.