Highmark Blue Cross Blue Shield for Therapy

Highmark Blue Cross Blue Shield is a health insurance plan offered through the large insurance company Highmark Health. It connects its members to the extensive Blue Cross Blue Shield network. Many individuals get access to Highmark Blue Cross Blue Shield through their employer, who provides health insurance as a benefit — encouraging their employees to take care of themselves and their mental health.

Does Highmark Blue Cross Blue Shield cover therapy?

Yes, Highmark Blue Cross Blue Shield provides its members with coverage for mental health services, including therapy. This means that you can use your Highmark Blue Cross Blue Shield plan to lower your out-of-pocket costs, making therapy more affordable. Working with an in-network therapist is the best way to lower your out-of-pocket costs, though you might also have out-of-network benefits when it comes to therapy.

The amount of coverage provided depends on your specific Highmark Blue Cross Blue Shield 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 so you can avoid unexpected bills.

How do I check if my Highmark Blue Cross Blue Shield plan covers therapy?

The best place to check whether your Highmark Blue Cross Blue Shield plan covers therapy is your Summary of Benefits document. You likely received this document when you first signed up for your Highmark Blue Cross Blue Shield plan. If you have an online account, log into this account and search for your Summary of Benefits document, then look for the line that describes mental or behavioral health services. If you’re struggling to understand your benefits, try giving Highmark Blue Cross Blue Shield 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.

How much does therapy cost with my Highmark Blue Cross Blue Shield plan?

The exact costs of therapy will vary based on which Highmark Blue Cross Blue Shield plan you have. However, you can expect to pay a copay between $20-100 per session when working with an in-network therapist. Highmark Blue Cross Blue Shield has multiple levels of in-network providers, which means that your copay may increase for the lower tier networks.

There are a few Highmark Blue Cross Blue Shield plans that do not provide any coverage for mental health services like therapy. Others provide no out-of-network coverage, meaning that you’ll be responsible for the full session fee, which may cost between $180-250 per session.

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

Highmark Blue Cross Blue Shield covers therapy services for many mental health conditions. Their requirement when it comes to mental health conditions is that it needs to be diagnosable — that is, your therapist must be able to give you a diagnosis. Highmark Blue Cross Blue Shield uses this diagnosis to track your progress as you go throughout your therapy journey.

Some common mental health conditions covered by Highmark Blue Cross Blue Shield include:

There are many more mental health conditions eligible for coverage under your Highmark Blue Cross Blue Shield plan. If you feel uncomfortable receiving a diagnosis or sharing your diagnosis with your insurance provider, you can pay for sessions with your therapist through a private pay option. While this is a more expensive option, it means you can see your therapist without worrying about a diagnosis.

What types of therapy does Highmark Blue Cross Blue Shield cover?

To be eligible for coverage from your Highmark Blue Cross Blue Shield plan, your therapist must be a credentialed mental health professional, which could be a psychologist, psychiatrist, social worker, licensed professional counselor, nurse practitioner, and more. Your therapist must also use a type of therapy that’s evidence-based, which means there is clinical research demonstrating its efficacy.

Here are some examples of clinically rigorous therapy types:

Many therapists blend their approaches in sessions with clients, drawing from multiple evidence-based therapy types to offer tailored sessions.

What types of therapy does Highmark Blue Cross Blue Shield NOT cover?

As stated above, Highmark Blue Cross Blue Shield does not provide coverage for types of therapy that aren’t evidence-based. Career counseling and life coaching, while helpful for some, are excluded from coverage for this reason.

Highmark Blue Cross Blue Shield also does not cover holistic therapies like nutritional therapy, aromatherapy, massage therapy, or reiki healing. While many people find these therapies helpful for their wellbeing, they lack the evidence required to be eligible for coverage.

Does Highmark Blue Cross Blue Shield cover online therapy?

Yes, you can use your Highmark Blue Cross Blue Shield therapy coverage for online sessions. You’ll pay just as much for online sessions as you would for in-person sessions, maintaining the same copay.

Does Highmark Blue Cross Blue Shield cover couples therapy?

Highmark Blue Cross Blue Shield does not give benefits for couples therapy. Because Highmark Blue Cross Blue Shield requires your therapist to report a diagnosis to receive coverage, couples therapy is not covered.

If you’re still interested in attending couples therapy, you might be able to access it through other options. Many couples find it helpful to work with a therapist to strengthen their relationship, and see paying for therapy as an investment.

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

Highmark Blue Cross Blue Shield plans are EPOs, which means that you do not need to see your primary doctor before starting therapy. You are free to start seeing a therapist on your own time, as you will not need a referral to access your Highmark Blue Cross Blue Shield benefits.