Eating Disorder Treatment
Eating disorder treatment is a covered benefit under psychotherapy and/or hospitalization for mental health. A prior authorization is required before being admitted for any eating disorder programs. The following Eating Disorder Checklist should be submitted with the authorization request to Health Net Federal Services, LLC.
Education or Counseling Services
Patient and parent education or counseling services are a limited benefit. Most education and training programs are not covered except for limited circumstances under the Extended Care Health Option (ECHO) program. The following education or counseling services are covered when included as part of an office visit by a physician or other TRICARE-authorized provider: dietary assessment and nutrition; physical activity and exercise; cancer surveillance; safe sexual practices; tobacco, alcohol, and substance abuse; accident and injury prevention; promoting dental health; stress, bereavement, and suicide risk assessment.
Elective Supplies or Services
Services or supplies that are not medically and/or psychologically necessary are not a covered benefit.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a limited benefit. Pre-authorization is required.
To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request.
Cost Information
Emergency Care
Outpatient emergency care received in an emergency room, both network and non-network, in or out of the region is covered. More >>
Cost Information
Epidural Steroid Injections
Epidural steroid injections (ESIs) in the cervical, lumbar and sacral (caudal block) regions are a covered benefit. Epidural steroid injections in the thoracic region are a limited benefit and may be covered only for disc herniations when the pain is radicular and unresponsive to conservative treatment.
If covered, the setting where the services are provided will determine costs; outpatient office setting, ambulatory surgery setting or inpatient hospital setting.
Experimental or Unproven Procedures
Not a covered benefit.
Eye Examinations
Routine eye exams are a limited benefit and coverage is based on beneficiary category. More >>
Eyeglasses or Contact Lenses
Eyeglasses and contact lenses are a limited benefit. More >>
