Anthem Blue Cross Blue Shield PPO Plan - Teamworks at Home ...

Chapter 4
Mental health and substance abuse benefts
If you enroll in the Anthem BCBS PPO Plan, you and
your covered dependents have coverage for in- and
out-of-network mental health and substance abuse
services described in this chapter�
As always, it is between you and your provider to
determine the treatments and procedures that best
meet your needs� The terms of this chapter control
what, if any, benefts are available under the Plan for the
mental health or substance abuse services you receive�
The fact that a provider has performed or prescribed
a procedure or treatment, or the fact that it may be
the only treatment for a particular sickness or mental
illness, does not mean that it is a covered mental health
or substance abuse service� The defnition of a covered
health service under the Plan relates only to what is
covered and may difer from what your provider deems
to be a necessary health service�
For mental health or substance abuse treatment to be
a covered health service, Anthem BCBS Behavioral
Health must determine that the treatment meets the
Anthem BCBS Behavioral Health coverage criteria
guidelines�
Anthem BCBS Behavioral Health
Anthem BCBS Behavioral Health (ABH) is the claims
administrator for mental health and substance abuse
benefts described in this chapter under this Anthem
BCBS PPO Plan, and provides confdential referrals for
managed mental health and substance abuse care� The
ABH network includes psychiatrists, psychologists, and
master’s level licensed therapists� Anthem Behavioral
Health is stafed 24 hours a day, 365 days a year� For
more information, see the “Contacts” section on
page 1� To receive benefts through ABH, you must
follow the process described in this chapter�
Anthem Blue Cross Blue Shield PPO Plan 55