Table 2.

Common Limitations in State Essential Health Benefits Plans.

1. Nonrecognition of chronic pain as a distinct entity in coverage statements

2. Noncoverage of evidence-based treatments endorsed by published guidelines

3. Limits on the number of individual and combined visits for rehabilitative and treatment that reduce the potential for multidisciplinary care and rehabilitation

4. Noncoverage of behavioral treatments based on nonmental health condition status versus evidence basis (DSM exclusions)

5. Noncoverage of treatments based on labeling versus evidence basis (eg, CAM exclusions)

6. Inconsistencies in coverage statements (eg, treatment covered in 1 section but denied in others)

Abbreviations: CAM, complementary and alternative medicine; DSM, Diagnostic and Statistical Manual of Mental Disorders.