Opinion ID: 3064958
Heading Depth: 2
Heading Rank: 2

Heading: “Contracted Providers-Inpatient Hospital”

Text: C. “Residential Treatment, Transitional Care, Day Treatment, Partial Hospitalization” DUPREE v. HOLMAN PROFESSIONAL COUNSELING 9941 contracted providers and non-contracted providers when discussing Residential Treatment Centers. In contrast, other sections in Category III make clear whether they refer to noncontracted provider benefits or contracted-provider benefits. For example, Category III includes separate sections with separate titles for non-contracted provider inpatient services (Section D — “Non-Contracted Providers-Inpatient Hospital”) and contracted provided inpatient services (Section B — “Contracted Providers-Inpatient Hospital”). It also includes separate sections for non-contracted provider outpatient services (Section E — “Non-Contracted Providers-Outpatient Services”) and contracted provided outpatient services (Section A — “Outpatient”). Category III includes, however, only one section for Residential Treatment (Section C — “Residential Treatment, Transitional Care, Day Treatment, Partial Hospitalization”). Moreover, non-contracted provider outpatient services are explicitly listed as “NOT A COVERED BENEFIT” in Category III, whereas Category III does not state that non-contracted provider Residential Treatment is not a covered benefit. I therefore believe that it is reasonable to interpret the Schedule of Benefits as covering Resident Treatment Center services from both non-contracted and contracted providers. Accordingly, I dissent and would hold that the treatment Dupree’s daughter, Alexandra Martini, received at Visions Residential Treatment Center should have been covered under Dupree’s Behavioral Health Plan. D. “Non-Contracted Providers-Inpatient Hospital” E. “Non-Contracted Providers-Outpatient Services” (listed as “NOT A COVERED BENEFIT”) F. “Ambulance”