blue cross blue shield is one of the largest health insurance companies in the us. uu. and provides coverage to one in three Americans, including mental health, behavioral health and therapy services. This guide describes Blue Cross Blue Shield’s coverage of therapy services.
does blue cross blue shield cover therapy?
yes, the vast majority of blue cross blue shield plans cover therapy.
Health insurance offered through the marketplace or through small employers is required by the Affordable Care Act to cover mental health services, and while not required by federal law, the vast majority of large employers also cover mental health services.
although rare, your blue cross blue shield plan may not cover therapy services if:
- works for a large employer that does not include mental health benefits in its insurance coverage.
- Your health insurance plan was created before 2014, when the aca requirement that health insurance plans cover mental health services was enacted. There are other situations where your blue cross blue shield plan may not cover the specific type of therapy service you are seeking, or where your coverage may not apply until you first spend a certain amount on medical services. Learn more about these cases below.
- $15 copay, after $5,000 deductible → after spending $5,000 on medical costs this year, your therapy sessions will cost $15 per session.
- $15 copay, after $1,000 deductible → after spending $1,000 on medical costs this year, your therapy sessions will cost $15 per session.
- $15 copay, deductible does not apply → your therapy sessions will cost $15 per session, regardless of your deductible amount (meaning even if this is your first doctor visit of the year, you will only pay $15 at the time of your therapy session).
- 20% coinsurance, after $5,000 deductible, therapist charges $100/session → after spending $5,000 on medical costs this year, your plan will reimburse you $80 of your therapy session fee; the cost of effective therapy from him is $20/session.
- 20% coinsurance, after $1,000 deductible, therapist charges $150/session → after spending $1,000 on medical costs this year, your plan will reimburse you $120 of your therapy fee each time you file a claim; the cost of effective therapy from him is $24/session.
- attention deficit/hyperactivity disorder (adhd)
- obsessive-compulsive disorder (OCD)
- eating disorders
- mood disorders, such as bipolar disorder
- substance use disorder
- cognitive behavioral therapy (cBT)
- dialectical behavior therapy (dtb)
- psychodynamic therapy
- acceptance and commitment therapy
- Life Coaching: Life coaching is not covered by insurance because it focuses on achieving personal goals, rather than treating a diagnosable mental health condition.
- career coaching: Career coaching is not covered by insurance because it focuses on achieving career goals, rather than treating a diagnosable mental health condition.
- hmo or pos plan: yes, you are generally required to see your primary care physician for a referral for therapy before blue cross blue shield will pay for services
- ppo or epo plan: no, you usually do not need to see your primary care doctor to get a referral for therapy before blue cross blue shield pays for services.
how do i check if my blue cross blue shield plan covers therapy?
To see if your blue cross blue shield plan covers therapy, look for the line item “outpatient mental health” in your summary of benefits. therapy is considered a type of outpatient mental health service. You can find your summary of benefits by logging into your blue cross blue shield member services portal (find your local blue cross blue shield company here), calling member services, or checking your employer’s benefits portal.
here is an example of what your blue cross blue shield summary of benefits might look like and where to find the outpatient mental health line item:
If the outpatient mental health line says these services are not covered, then your health insurance plan does not cover therapy services.
If you can’t find information about outpatient mental health coverage, contact your local blue cross blue shield member services, or if you receive health insurance through your employer, contact the health department. human resources from your employer.
While your blue cross blue shield plan will likely cover therapy, the extent of coverage and the requirements for coverage depend on your particular plan. read on for more information.
how much does therapy cost with a blue cross blue shield plan?
If you choose a therapist who is in the blue cross blue shield network, your therapy sessions will likely cost between $15 and $50 per session, after you meet your deductible. the $15 – $50 amount is your copayment, or the fixed amount you owe at each therapy visit. The deductible is the total amount you must spend on medical costs in a given year before your health insurance begins to cover the cost of services. Here are some examples you might see on your Summary of Benefits under the “in-network outpatient mental health” category and what they mean:
if you choose a therapist who is not in the blue cross blue shield network and has a blue cross blue shield ppo plan, your therapy session will likely cost between $50 and $100 per session, or 20% – 50% of the total amount your therapist charges per session. this percentage is called coinsurance: you pay the therapist’s full fee at the time of the session, submit a claim to your health insurance company, and receive a check or direct deposit for the remaining percentage your plan generally covers, ppo plans only cover out-of-network services after you meet your deductible. Here are examples you might see on your Summary of Benefits under the “out-of-network outpatient mental health” category and what they mean:
if you choose a therapist who is not in the blue cross blue shield network and you have a blue cross blue shield hmo or epo plan, your plan may not reimburse you for sessions with a therapist who is not in the blue cross blue shield network. you will owe the therapist the full fee at the time of the session and will not receive a refund from your plan. If cost is a barrier to seeking therapy, you can find a therapist who offers a sliding scale or lower session fees based on financial need.
what mental health conditions does blue cross blue shield cover?
mental health conditions covered by blue cross blue shield may include:
Please note that therapists must assign you a diagnosis for the above conditions, as well as share the diagnosis with your health insurer, if you are using insurance benefits to pay for therapy.
If you don’t want your insurance company (or family members, if you have a shared plan) to have access to this information about your mental health, consider out-of-network options.
what types of therapy does blue crossblue shield cover?
blue cross blue shield plans cover most types of therapy, including individual therapy and child therapy, as well as different types of therapy approaches, including:
Any type of evidence-based therapy used for the diagnosis and treatment of mental health conditions must be covered by blue cross blue shield plans.
what types of therapy does blue cross blue shield not cover?
Like most insurance, not blue cross blue shield typically covers services not related to a diagnosable mental health condition, such as:
Blue Cross Blue Shield is unlikely to cover therapy sessions that take place outside of the therapy office, due to the higher potential risk involved. While clients can sometimes benefit from services provided outside of the therapy office, such as a client with an eating disorder who needs support at the grocery store, or a client with a driving phobia who needs support in the car, there is little These services are likely to be needed. covered by insurance and must be paid out of pocket.
does blue cross blue shield cover online therapy?
yes, most blue cross blue shield insurance plans cover online therapy, and many blue cross blue shield chapters have partnerships with online networks, such as live health online.
You can check those directories or ask member services if online sessions with the therapist of your choice are covered.
Does blue cross blue shield cover couples counseling?
not. Although it depends on your specific plan, it is unlikely that Blue Cross Blue Shield will cover couples counseling.
That said, even if your insurance doesn’t cover you directly, you still have options for affordable couples counseling. Here are five ways to pay for couples counseling if it’s not included in your health insurance plan.
do I need to see my doctor before seeing a blue cross blue shield therapist?
Whether you need to see your primary care doctor before seeing a blue cross blue shield therapist depends on your type of insurance plan:
This referral requirement is also called prior authorization (or prior authorization). Prior authorization is a process where a health care provider, in this case your therapist, must obtain approval from your insurance company before providing care for services to be covered. Your summary of benefits should state if you need prior authorization for outpatient mental health services.
note: while “the blue cross and the blue shield” are often referred to as a single entity, “the blue cross and blue shield association” is in fact comprised of 36 locally operated companies. While the following guide provides an overview of Blue Cross Blue Shield therapy coverage, it is important to check your specific plan as each regional affiliate, and within them, each plan, has a unique level of coverage.