MMC Benefits Handbook
Occupational Therapy
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
The plan covers the treatment to:
  • Learn or re-learn daily living skills (e.g., bathing, dressing and eating) or compensatory techniques to improve the level of independence in the activities of daily living
  • Provide task-oriented therapeutic activities designed to significantly improve, develop or restore physical functions lost or impaired as a result of a disease.
Coverage includes services, treatment, education testing or training related to developmental delays.
Prior authorization for occupational therapy is recommended. Contact the Claims Administrator for specific details.