Blue Cross Blue Shield for Therapy
Blue Cross Blue Shield is one of the largest health insurance companies in the U.S., providing coverage for one in three Americans -- including mental health, behavioral health, and therapy services. This guide outlines 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 insurances offered through the Marketplace or through small employers are 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.
While rare, your Blue Cross Blue Shield plan may not cover therapy services if:
- You work 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’s requirement that health insurance plans cover mental health services was enacted.There are other situations in which 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 spend a certain amount on medical services first. Learn more about these cases below.
How do I check if my Blue Cross Blue Shield plan covers therapy?
To check whether your Blue Cross Blue Shield plan covers therapy, look for the “Outpatient Mental Health” line item on 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 may look like, and where to find the Outpatient Mental Health line item:
If the Outpatient Mental Health line item indicates that these services are not covered, then your health insurance plan does not cover therapy services.
If you cannot find coverage information for Outpatient Mental Health, contact your local Blue Cross Blue Shield Member Services, or if you receive health insurance through your employer, reach out to your employer’s human resources department.
While your Blue Cross Blue Shield plan likely covers therapy, the extent of coverage and requirements for coverage depend on your particular plan. Read on to learn more.
How much does therapy cost with a Blue Cross Blue Shield plan?
If you choose a therapist who is in-network with Blue Cross Blue Shield, your therapy sessions likely cost between $15 - $50 per session, after you meet your deductible. The $15 - $50 amount is your copay, or the fixed amount that you owe at each therapy visit. The deductible is the total amount you need to spend in medical costs in any given year before your health insurance begins to cover the cost of services. Here are examples you may see on your Summary of Benefits under the “In-network Outpatient Mental Health” category and what they mean:
- $15 copay, after $5,000 deductible → After you spend $5,000 in medical costs this year, your therapy sessions will cost $15 per session.
- $15 copay, after $1,000 deductible → After you spend $1,000 in 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 (ie. even if this is your first medical visit of the year, you will only pay $15 at the time of your therapy session).
If you choose a therapist who is not in-network with Blue Cross Blue Shield and you have a Blue Cross Blue Shield PPO Plan, your therapy session will likely cost between $50 - $100 per session, or 20% - 50% of the full amount that your therapist charges per session. This percentage is called a coinsurance: you pay the therapist’s full fee at the time of the session, send a claim to your health insurance company, and receive a check or direct deposit for the remaining percentage that your plan covers. PPO plans typically only cover out-of-network services after you meet your deductible. Here are examples you may see on your Summary of Benefits under the “Out-of-Network Outpatient Mental Health” category and what they mean:
- 20% coinsurance, after $5,000 deductible, therapist charges $100/session → After you spend $5,000 in medical costs this year, your plan will reimburse you $80 of your therapy session fee; your effective therapy cost is $20/session.
- 20% coinsurance, after $1,000 deductible, therapist charges $150/session → After you spend $1,000 in medical costs this year, your plan will reimburse you $120 of your therapy fee each time you submit a claim; your effective therapy cost is $24/session.
If you choose a therapist who is not in-network with Blue Cross Blue Shield and you have a Blue Cross Blue Shield HMO or EPO Plan, your plan will likely not reimburse you for sessions with a therapist who is not in-network with Blue Cross Blue Shield. You would owe the therapist’s full fee at the time of session and not receive reimbursement from your plan. If cost is a barrier to seeking therapy, you can look for 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 Blue Cross Blue Shield covers may include:
- Attention-deficit/hyperactivity disorder (ADHD)
- Obsessive Compulsive Disorder (OCD)
- Eating disorders
- Mood disorders, such as bipolar disorder
- Substance use disorder
Note that therapists are required to 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 instead.
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:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Psychodynamic Therapy
- Acceptance and Commitment Therapy
Any therapy type that is evidence-based and utilized for the purposes of diagnosis and treatment of mental health conditions should be covered by Blue Cross Blue Shield plans.
What kinds of therapy does Blue Cross Blue Shield not cover?
Like most insurances, it is not typical for Blue Cross Blue Shield to cover services unrelated to a diagnosable mental health condition, such as:
- Couples counseling - Couples counseling is typically not covered by insurance, because relationship issues, while a significant source of stress, are not considered a diagnosable mental health condition.
- 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 professional goals, rather than treating a diagnosable mental health condition.
Blue Cross Blue Shield is also unlikely to cover therapy sessions occurring outside the therapy office, because of the greater potential for risk involved. While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance and must be paid for out-of-pocket.
Does Blue Cross Blue Shield cover online therapy?
You can go through those directories, or ask member services whether online sessions with your therapist of choice are covered.
Does Blue Cross Blue Shield cover couples counseling?
No. While 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 directly cover it, you still have options for getting 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 visiting a Blue Cross Blue Shield therapist?
If you need to see your primary care doctor before visiting a Blue Cross Blue Shield therapist depends on your insurance plan type:
- HMO or POS plan: Yes, you are typically required to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services
- PPO or EPO plan: No, you typically don’t need to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.
This referral requirement is also called pre-authorization (or prior authorization). Pre-authorization is a process where a health provider, in this case your therapist, must get approval from your insurance company before providing you with care in order for the services to be covered. Your Summary of Benefits should indicate whether you need pre-authorization for outpatient mental health services.
Note: While “Blue Cross and Blue Shield” is often referenced as one entity, “The Blue Cross and Blue Shield Association” is in fact composed of 36 locally operated companies. While the following guide provides an overview of Blue Cross Blue Shield therapy coverage, it’s important to check your specific plan, as each regional affiliate, and within those, each plan, has a unique level of coverage.