Blue Cross Blue Shield of MA HMO for Therapy

Blue Cross Blue Shield is a large health insurance company that insures millions of Americans. In Massachusetts, Blue Cross Blue Shield provides an HMO plan to provide coverage of medical and behavioral healthcare services for its members — and this includes therapy! The Blue Cross Blue Shield HMO plan uses the expansive Blue Cross Blue Shield provider network, which includes thousands of excellent therapists.

Does Blue Cross Blue Shield of MA HMO cover therapy?

Yes, Blue Cross Blue Shield of MA provides coverage for therapy services. However, the Blue Cross Blue Shield of MA HMO plan only includes coverage for mental health benefits with an in-network therapist — that is, a therapist that contracts with Blue Cross Blue Shield of MA. Seeing an in-network therapist is typically the most cost-effective way to access mental healthcare, and with Blue Cross Blue Shield’s large provider network, you have the opportunity to find a great therapist in Massachusetts.

How do I check if my Blue Cross Blue Shield of MA HMO plan covers therapy?

To check if your Blue Cross Blue Shield of MA HMO plan covers therapy, look  through your Summary and Benefits document. Under the line item “outpatient care” that reads “mental health or substance use treatment.” This will tell you how much it will cost per visit with your in-network therapist.

Most health insurance companies post the Summary and Benefits document within their online portals, so check for this document through your Blue Cross Blue Shield online account. Another way to learn more about your coverage is to find the customer service number on the back of your insurance card. The customer service agent will either point you in the right direction of where to find your mental health benefits or share with you the amount of coverage you have under your plan.

How much does therapy cost with the Blue Cross Blue Shield of MA HMO plan?

With the Blue Cross Blue Shield of MA HMO health insurance plan, expect to pay a copayment of $25 per visit with your in-network therapist. This means that each time you see your therapist for a session, you’ll pay $25 out-of-pocket. These benefits begin even before you reach your deductible, which means that you won’t have to spend a certain amount before you receive coverage for therapy services. Without needing to reach your deductible, you’re free to start therapy that’s budget friendly at any point throughout the year.

What types of mental health conditions does Blue Cross Blue Shield of MA HMO cover?

Blue Cross Blue Shield of MA HMO mental health benefits include treatment for the following mental health conditions and more:

• Depression
• Anxiety and stress
• Alcohol abuse
• Drug abuse
• Grief and loss
• Eating disorders
• Obsessive compulsive disorder (OCD)

When you start therapy, your therapist will designate a diagnosis for your condition or goals. They’ll share this diagnosis with Blue Cross Blue Shield of MA to ensure coverage.

What types of therapy does Blue Cross Blue Shield of MA HMO cover?

Blue Cross Blue Shield of MA covers many different evidence-based therapy approaches and modalities. To be considered an evidence-based therapy, there must be clinical rigor behind the treatment. Some examples of evidence-based therapy types include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Mindfulness practices
• Psychodynamic therapy
• Acceptance and Commitment Therapy (ACT)

To provide coverage for treatment, Blue Cross Blue Shield of MA requires that therapists provide diagnosis-based therapy appropriate for the mental health diagnosis. As long as the therapist provides Blue Cross Blue Shield a diagnosis for the client and complete the reimbursement process, they may blend together a few modalities to create their own personalized approach.

What types of therapy does Blue Cross Blue Shield of MA HMO NOT cover?

Blue Cross Blue Shield of MA will not provide coverage for therapy costs associated with services that are not evidence-based. This means that all treatment modality needs to have empirical research backing its efficacy.

Blue Cross Blue Shield of MA does not cover life coaching and career coaching, as these disciplines are less based on evidence and are more reliant on goal-setting and achievement outcomes. There is also no coverage for holistic approaches to treatment like aromatherapy, massage therapy, acupuncture, reiki healing, or nutritional therapy. They also do not cover ketamine and psychedelic treatments, even if the purpose of this treatment is for a mental health condition.

However, Blue Cross Blue Shield offers a Mind Body Wellness program for an additional yearly cost. This program provides some coverage for massage, acupuncture, hypnosis, meditation, and Tai Chi, so it may be beneficial if you’re interested in these services as part of your mental health treatment.

Does Blue Cross Blue Shield of MA HMO cover online therapy?

Yes, Blue Cross Blue Shield of MA covers online therapy. They provide the same rate of coverage for online therapy as they do for in-person visits, which means that your coinsurance rates will remain the same for both in-network and out-of-network therapists.

Having an online option is helpful for many individuals who prefer accessible, convenient teletherapy on a secure video platform. Many people who have the Blue Cross Blue Shield of MA HMO partake in online therapy for these reasons.

Does Blue Cross Blue Shield of MA HMO cover couples therapy?

No, Blue Cross Blue Shield of MA does not provide coverage for couples counseling. This is in part because it’s difficult for therapists to provide a reimbursable diagnosis for couples, as opposed to individuals.

However, there are still ways to access couples counseling even if your insurance does not cover it. Here are five ways to pay for couples counseling, if it’s something of interest to you. You may include your partner or partners in your individual sessions, depending on your therapist’s treatment style — in which case, Blue Cross Blue Shield of MA may provide coverage for the session.

Do I need to see my primary care doctor before starting therapy?

Yes, you will need to receive a referral from your primary care physician before you begin therapy. Because this Blue Cross Blue Shield plan is an HMO, referrals are required for all visits to specialists — if there isn’t a referral, you may not receive reimbursement.

However, it’s often not difficult to receive a referral for mental health services. Your primary care physician may recommend a few therapists in the area. You might also use Zencare to search for therapists that take the Blue Cross Blue Shield HMO health insurance plan, where you can view each therapists’ introductory video and schedule a free consultation call.