Blue Cross Blue Shield of MA PPO | Mental Health Insurance Coverage — Zencare

Blue Cross Blue Shield of MA PPO for Therapy

Blue Cross Blue Shield is a large health insurance company that insures millions of Americans across the country. In Massachusetts, Blue Cross Blue Shield offers a PPO plan to provide coverage of medical and behavioral healthcare services for its members — this includes therapy! The Blue Cross Blue Shield of Massachusetts PPO provider network is extensive and includes thousands of excellent therapists.

Does Blue Cross Blue Shield of MA PPO cover therapy?

Yes, Blue Cross Blue Shield of MA provides coverage for therapy services. The Blue Cross Blue Shield of MA PPO plan includes both in-network and out-of-network mental health benefits, which means that you’ll pay less to see any therapist, even if they aren’t in the Blue Cross Blue Shield provider network.

Besides provider network status, how much you pay for therapy will depend on your therapist’s session fees. However, when using your Blue Cross Blue Shield of MA PPO plan coverage, you won’t have to pay for the full session fee on your own.

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

To check if your Blue Cross Blue Shield of MA PPO plan covers therapy, read through your Summary and Benefits document. Look for the line under “outpatient care” that reads “mental health or substance use treatment.” This will tell you what your fee responsibilities will be for each visit to your therapist.

Example Blue Cross Blue Shield PPO Summary of Benefits, with Outpatient Mental Health section highlighted

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 PPO plan?

The cost of therapy under the Blue Cross Blue Shield of MA PPO plan varies based on your therapist’s fees and whether or not they’re an in-network provider. These benefits begin after you’ve met your deductible. Each time you see your therapist, except to pay a coinsurance rate of 10% for an in-network provider and 30% for out-of-network providers. Coinsurance rates are the percentage of the therapist’s fees that you’ll pay — so if your in-network therapist charges $250 per session, you’ll be responsible for $25 each time you have a session.

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

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

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. This is essential for coverage of your therapy sessions. If you would prefer that your therapist doesn’t disclose your diagnosis with Blue Cross Blue Shield of MA, consider your out-of-network options. This way, your mental health care stays between you and your therapist — not the insurance company and anyone who has access to your insurance account information.

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

Blue Cross Blue Shield of MA covers many different evidence-based therapy approaches and modalities. This includes but is not limited to:

To provide coverage for treatment, Blue Cross Blue Shield of MA requires that therapists provide diagnosis-based therapy appropriate for the mental health diagnosis.

What types of therapy does Blue Cross Blue Shield of MA PPO 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 PPO 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 PPO partake in online therapy.

Does Blue Cross Blue Shield of MA PPO 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?

No, you do not need to see your primary care doctor before starting therapy. This is because this specific Blue Cross Blue Shield of MA is a PPO plan, which means that there are no referrals necessary before seeing a specialist. With a PPO plan, there’s more flexibility in picking your providers, so you’ll have the opportunity to find a great therapist near you that fits your needs, personality, and preferences. Since you don’t need a referral or to visit your primary care physician before starting therapy, you can begin your therapist search as soon as you’re ready!