CareFirst for Therapy
CareFirst, also called CareFirst Blue Cross Blue Shield, is a health insurance plan that offers its members access to healthcare services, including mental health and well-being services like therapy.
Does CareFirst cover therapy?
Yes, CareFirst provides its members with coverage for mental health services, including sessions with a therapist. Using your CareFirst plan is a great way to lower your out-of-pocket costs so you don’t have to pay session fees completely on your own. CareFirst plans generally provide more benefits when you work with an in-network therapist than an out-of-network therapist, as is common for many insurance plans.
There are dozens of types of CareFirst plans, so the amount of coverage provided depends on your specific plan. Because there are many different plans offered, it’s important to understand the exact details of your plan before you start working with a therapist. That way, you can avoid unnecessary costs and keep within your budget.
How do I check if my CareFirst plan covers therapy?
Locate your CareFirst plan’s Summary of Benefits document. This document gives you an idea of how much coverage your CareFirst plan offers you by service type. You can find this document through your online CareFirst account. If you receive CareFirst as a benefit from your workplace, ask your HR team if they can provide you with this document.
Within the Summary of Benefits document, located the line related to “Mental Health and Substance Disorder.” You’ll then look under “Office Visits” to see what your plan offers in terms of therapy sessions. You’ll see this item broken down into in-network and out-of-network, with different coverage rates for each one.
If you’re struggling to understand your benefits, try giving CareFirst a call — their number is on the back of your insurance card. Ask them about whether you’ll be responsible for a copay or for coinsurance when it comes to outpatient mental health services. You might also want to ask them for information on working with an in-network versus out-of-network therapist and for help finding an in-network therapist in your area.
How much does therapy cost with my CareFirst plan?
The exact costs of therapy will vary based on which CareFirst plan you have — and there are dozens of types of CareFirst plans, so the amount that you’ll need to pay can vary widely. CareFirst members have free access to an online platform called CloseKnit. CloseKnit offers members free access to therapists. It’s available to members around the clock at no charge, making this a really good way to work with a therapist. Other in-network therapy sessions outside of CloseKnit are also generally free for members.
If you decide to see an out-of-network therapist, you’ll be responsible for reaching your deductible first before your benefits kick in. This means that you may need to pay for the first few sessions in their entirety before your insurance begins covering any cost of your therapy sessions. Then, you’ll be responsible for a 20% coinsurance, meaning that you’ll need to pay 20% of the session fee each time you work with a therapist. This could amount to around $40 per session.
What types of mental health conditions does CareFirst cover?
CareFirst covers therapy services for many mental health conditions and life situations. When seeing a therapist through CloseKnit, you don’t need to receive a diagnosis for continued care. However, when working with a therapist outside of this platform, you may need to receive a specific diagnosis from your therapist to continue to receive your CareFirst benefits. This is because CareFirst needs to be able to track your progress to ensure their coverage is being appropriately used.
Some common mental health conditions covered by CareFirst include:
- Alcohol abuse
- Drug abuse
- Grief and loss
- Eating disorders
- Obsessive compulsive disorder (OCD)
What types of therapy does CareFirst cover?
To be eligible for coverage from your CareFirst plan, your therapist must be a credentialed mental health professional. They might be a psychologist, psychiatrist, social worker, licensed professional counselor, nurse practitioner, and more. Your therapist must also use an evidence-based therapy modality, which means there is clinical research that demonstrates its efficacy.
Here are some examples of evidence-based therapy modalities:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Acceptance and Commitment Therapy (ACT)
- Exposure and Response Prevention Therapy
- Internal Family Systems (IFS)
Most therapists blend together multiple therapy modalities for a tailored therapy offering, based on the needs of their client.
What types of therapy does CareFirst NOT cover?
As stated above, CareFirst does not provide coverage for types of therapy that don’t have clinical rigor. Career counseling and life coaching, while helpful for many, are excluded from coverage for this reason, as they are broad terms that describe a wide range of both clinically robust and generic forms of support.
CareFirst also does not cover holistic therapies like nutritional therapy, aromatherapy, massage therapy, or reiki healing. While many people find these therapies helpful for their well-being, they lack the evidence required to be eligible for coverage.
Does CareFirst cover online therapy?
Yes, you can use your CareFirst therapy coverage for online sessions. CareFirst offers its members access to many online platforms, one being CloseKnit. CloseKnit can be the platform through which you work with your therapist regularly, and is entirely online. CareFirst also offers its members access to CareFirst Wellbeing, another online platform that provides members with educational mental health resources and personalized wellness programs.
For individuals who want to use their CareFirst benefits to work with an online therapist outside of CloseKnit, they’ll pay the same amount they would normally pay when seeing a therapist in-person, such as the same coinsurance rate.
Does CareFirst cover couples therapy?
CareFirst does not cover couples therapy. Because CareFirst requires your therapist to report a diagnosis to receive coverage, couples therapy is generally not covered by insurance plans.
There are other options to leverage if you still want to work with a couples therapist, despite not receiving insurance benefits for this service.
Do I need to see my primary doctor before starting therapy?
CareFirst plans can either be HMO or PPO plans. If you have a CareFirst HMO plan, you will need to see your primary doctor before starting therapy. This is because you need a referral in order to access your insurance benefits, as therapists are seen as specialists. If you have a CareFirst PPO plan, however, you do not need this referral and can begin working with a therapist as soon as you’re ready to begin therapy.