2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Residential Treatment Center

 

Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.

Benefit Description

Residential Treatment Center
Inpatient Residential Treatment Center:

Precertification prior to admission is required.

We cover inpatient care provided and billed by an RTC when the care is medically necessary for the treatment of a medical, mental health, and/or substance use disorder:
 
  • Room and board, such as semiprivate room, nursing care, meals, special diets, ancillary charges, and covered therapy services when billed by the facility.

Notes:
 
  • For inpatient care received overseas, refer to Section 5(i).
     
  • For outpatient residential treatment center services, see Section 5(c).


You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)

Non-preferred facilities (Member/Non-member): You pay all charges

 

Benefit Description
Not covered services, such as:
 
  • Biofeedback
     
  • Custodial or long-term care (see Definitions)
     
  • Domiciliary care provided because care in the home is not available or is unsuitable
     
  • Educational therapy or educational classes
     
  • Equine/hippotherapy provided during the approved stay
     
  • Recreational therapy
     
  • Respite care
     
  • Outdoor residential programs
     
  • Outward Bound programs
     
  • Personal comfort items, such as guest meals and beds, phone, television, beauty and barber service
     
  • Services provided outside of the provider’s licensure/scope of practice

Note: Residential treatment center benefits are not available for facilities licensed as skilled nursing facilities, group home, halfway house or similar type facilities.


You Pay
All charges