Which Treatment Setting is Right for You?
If you need care for a behavioral health condition, there are many treatment settings available. What are they and how do you know which is right for you? The choice is personal. But understanding your options can help. Here we offer basic descriptions of the most common treatment settings. (You should always check your benefits to see what settings your plan covers.)
Not all facilities or programs meet our medical necessity criteria. All of these in-network facilities meet our criteria. To find out if an out-of-network facility meets our criteria, please call us at 800-868-1032.
Office
Office visits can provide different types of therapy, depending on the type of provider. There are many different types of providers who offer office visits. Office visits provide care for patients who can be treated outside of an intensive outpatient program (IOP), partial hospitalization program (PHP) or inpatient program.
IOP
IOPs are for patients who need less intense care than is given in a PHP or inpatient setting, but are in need of more care than can be given during office visits. Treatment times are usually shorter and less frequent than for PHPs. For example, an IOP may offer treatment three days per week for three hours per day. Treatment times depend on the patient’s specific condition and benefits. The care is well-planned. It can include group therapy, individual therapy, family therapy, medication management, recovery counseling and more.
PHP
A PHP is an outpatient treatment setting for those who need less intense care than is given in an inpatient setting. Treatment times vary, depending on the patient's specific condition and benefits. Programs are usually at least six hours per day, up to five days per week. The care is structured. It can include group therapy, individual therapy, family therapy, medication management, recovery counseling and more.
Inpatient
At this level of care, licensed staff closely monitor and treat severe symptoms 24 hours per day. The inpatient setting also allows staff to safely give certain treatments that cannot be performed in an outpatient setting. The inpatient hospital provides daily medical care or monitoring, as needed. The goal of this treatment setting is to provide well-planned treatment to stabilize the patient.
Residential Treatment Center (RTC)
An RTC also provides 24-hour care. Patients who receive care at an RTC may have treatment that is being continued after serious symptoms have become stable. The length of a stay at an RTC can vary.
Check your schedule of benefits to see whether your plan covers this treatment setting.
Boarding IOP or PHP
With boarding IOP or PHP service, the patient is at a facility each day and night, rather than coming for treatment and going home. This is a 24-hour level of care. IOP and PHP may be available with or without boarding.
Most plans do not cover boarding. Check your schedule of benefits to see if boarding is a covered benefit.
Wilderness Camp
Wilderness camps offer programs that provide outdoor therapy, usually to younger patients, such as teenagers. This is usually a 24-hour treatment setting that uses therapy and outdoor experiences to treat members who need long-term care.
Most plans do not cover wilderness camps. Check your schedule of benefits to see whether your plan covers this treatment setting.