Psychiatric Inpatient Hospitalization

Inpatient psychiatric hospitalization is covered when a patient requires 24-hour physician-supervised, active treatment under an individualized plan because of acute psychiatric symptoms that cannot be managed safely or effectively in a lower level of care. Coverage requires documented physician certification/recertification, weekly physician evaluation, written informed consent (per state law), and medical record evidence of active treatment and medical necessity; custodial, recreational, protocol-only, or non-acute chronic care and specified non-medical procedures are excluded.

"Patient requires intensive, comprehensive, multifaceted treatment including 24-hour medical supervision and coordination because of a mental disorder."

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