The short answer is that most Blue Cross Blue Shield plans cover therapy. The longer answer is that BCBS is not one company, so what someone else pays and what you pay can look quite different.
We put this guide together to help you figure out your own coverage without spending an afternoon on hold. Below, we cover what is usually included, what the cost terms actually mean, and what to do if a claim gets denied.
What Is Blue Cross Blue Shield, Exactly?
Blue Cross Blue Shield is a federation rather than a single insurer. The Blue Cross Blue Shield Association licenses the name to 33 independent, community-based companies that operate in their own regions, which is why you see names such as Anthem, Florida Blue, Highmark, and Premera on member cards.Each company sets its own networks, session rates, and prior authorization rules.
Does Blue Cross Blue Shield Cover Therapy?
In most cases, yes. Marketplace plans and most employer plans treat mental health care as an essential health benefit, which means outpatient therapy is part of the covered benefit package.
Federal parity rules add a second layer of protection. The Mental Health Parity and Addiction Equity Act generally prevents a plan that covers mental health care from putting harder limits on it than on comparable medical care, such as higher co-pays or stricter visit caps. The law does not by itself require a plan to offer mental health benefits, so the essential health benefit rules and your specific plan documents still matter.
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What Kinds of Therapy Does BCBS Usually Cover?
Coverage varies by company and plan, but these are the services most often included.
- Individual outpatient therapy. Regular sessions with a licensed therapist, in person or by video. This is the most consistently covered service.
- Psychiatric care and medication management. Visits with a psychiatrist or psychiatric nurse practitioner, usually billed separately from therapy.
- Group therapy. Often covered at a lower per-session cost than individual sessions.
- Family or couples sessions. Coverage here varies more than it does for individual therapy, and often depends on whether the sessions are tied to a diagnosis.
- Higher levels of care. Intensive outpatient and partial hospitalization programs are commonly covered, though these more often require prior authorization.
What Will I Actually Pay for Therapy?
There are four important terms to know that may be on your plan summary:.
- Deductible. The amount you pay out-of-pocket each year before your plan starts paying its share. Some plans apply it to therapy and some do not.
- Co-pay. A flat amount you pay at each session, such as $25 or $40, regardless of what the therapist charges.
- Coinsurance. A percentage of the session cost you pay instead of a flat fee, such as 20 percent, with the plan covering the rest.
- Out-of-pocket maximum. The most you will pay in a plan year. Once you reach it, covered care is generally paid in full for the rest of the year.
Whether you owe a co-pay or coinsurance depends on your plan’s structure
How Do I Check What My Plan Covers?
This takes a few minutes and may save you surprise bills later.
- Find the member services number on the back of your card and ask specifically about outpatient behavioral health benefits.
- Ask what you pay per session, whether a deductible applies, and how much of it is left this year.
- Ask whether you need a referral or prior authorization before starting.
- Ask what your plan pays for out-of-network therapists, if anything.
- Write down the date, the representative’s name, and what you were told.
What if My Therapist Is Out-of-Network?
Many therapists do not join insurance networks, so this comes up often. If your plan includes out-of-network benefits, you generally pay the therapist directly and your plan reimburses part of it afterward.
Ask the therapist for a superbill, which is an itemized receipt with the codes your plan needs. Ask your plan how much of the session cost it reimburses out-of-network and whether a separate out-of-network deductible applies. Plans that only cover in-network care will not reimburse these sessions at all.
What if My Claim Is Denied?
A denial is not the last word. You can file an internal appeal with your plan, generally within 180 days of the denial notice, and the plan has to explain its decision in writing.
If the plan still says no, you can request an external review by an independent reviewer, usually within four months of the final denial. Insurers are required to accept that reviewer’s decision. Your state Consumer Assistance Program or Department of Insurance can help you file.
What if Therapy Still Is Not Affordable?
Even with coverage, a deductible can make the first months expensive. Ask therapists directly about sliding-scale spots, since many hold a few and do not advertise them. Federally funded community health centers are required to adjust fees based on ability to pay and cannot turn someone away for inability to pay. SAMHSA also runs a confidential treatment locator that filters by the kinds of payment a program accepts.
How Do I Find a Therapist Who Takes My BCBS Plan?
Your plan’s own provider directory is the natural starting point, though directories go out of date, so call the therapist to confirm they are in-network and taking new clients. Your primary care doctor may also keep a referral list.
We created Mental Health Match to make this part easier, and it is free to use. You answer a few questions about what you are dealing with and what you want in a therapist, including your insurance, and our free matching tool introduces you to therapists who fit. We are one option among several, and your plan directory and your doctor are both reasonable places to look.
| Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It is also not insurance or legal advice, and your own plan documents govern your coverage. Always talk to a qualified healthcare professional about any medical concerns. If you are in crisis, please call or text the 988 Suicide & Crisis Lifeline at 988. |
