Mental Health & Chemical Dependency Benefits Program

All Inpatient Care must be pre-approved by PacifiCare Behavioral Health (PBH) 1- (877-225-2267). Benefits are only payable for Inpatient Care provided by an In-Network facility under contract with PBH.

Services for the treatment of nervous and mental disorders and chemical dependency are a covered benefit, only if such services offer a reasonable expectation of improvement, and are at the least restrictive level of care providing effective treatment as determined by PBH and consistent with safe medical practices.

For the purposes of this Program, a Mental Disorder and Chemical Dependency are defined below, and all treatment must meet this definition to be eligible for the benefits under the Program.

A Mental Disorder or Chemical Dependency is any disorder that involves a clinically-significant behavioral or psychological syndrome or pattern; is associated with serious symptoms; impairs a participant's ability in one or more major life functions or activities; is a condition listed as an Axis I Disorder (except V Codes) of the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and is not solely a character disorder Axis II), problem of living, or for personal exploration, desire of self-fulfillment, or forensic evaluation. The services must be clinically/medically appropriate for the condition being treated.