Guidelines for When a Therapist is Seeing a Member More Than Once Weekly in Outpatient Treatment
Guidance about when a therapist may see a Health Net member more than once weekly in outpatient psychotherapy; describes plan stance, review triggers, and intended short-term use for heightened clinical need. Applies to Health Net outpatient behavioral health providers and claims/utilization review processes.
No material clinical or coverage changes in this revision.
When Increased Session Frequency Is Covered
Use conditions for increased session frequency
Covered when used short-term for heightened clinical need.
Treating provider discretion; plan may review outliers if practice patterns suggest non‑clinical utilization.
Cases identified as outliers through population management reports or provider practice patterns may be reviewed.
The plan's position is that more than one session per week of outpatient psychotherapy is intended for short‑term use only. Such increased frequency should be driven by more intense clinical needs or scheduling logistics and used on a brief basis at the treating provider's discretion.
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