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Behavioral Health Exclusions

This is not an all-inclusive list. Contact ValueOptions at 1-800-700-8646 for additional information .

• Aversion treatment (except Antabuse is covered)
• Biofeedback (is covered for some medical conditions)
• Counseling not medically necessary in the treatment of a diagnosed medical condition–stress management, job counseling, lifestyle changes
• Court ordered treatment that is not medically or psychologically necessary (if it is also medically necessary, court ordered treatment is a benefit)
• Domiciliary care or custodial care
• Experimental or unproven procedures
• Inappropriate level of care- Services conducted in a setting that could have been completed just as safely and appropriately in a less restrictive setting
• Individual outpatient therapy for chemical dependency
• Inpatient care for the purpose of rest or respite
• Inpatient stays primarily to control a runaway child
• Services associated with an inpatient stay that were not authorized  (or services provided on days in which inpatient care was in denial)
• Treatment for specific learning disorders
• Light therapy for Seasonal Affective Disorder
• Methadone maintenance for opiate dependence
• Non-authorized TRICARE provider- any services provided by a non-authorized TRICARE provider
• Psychoanalysis or psychotherapy for educational purposes
• Psychological testing in the following situations: assessment for academic placement; testing related to educational programs, issues, or deficiencies and testing related to learning disorders; child custody or job placement; testing for general screening for the presence of a mental disorder and teacher/parental referrals for testing.
• Psychotherapy for weight reduction or obesity
• Psychotherapy related to transsexualism, gender dysphoria, paraphilias, sexual dysfunction or sexual inadequacy
• Sensory integration
• Smoking cessation programs
• Speech therapy other than for a physical illness/defect, and is not available through a public institution such as the school system.
• V-code diagnoses for Mental Health