Health Insurances Blue Cross Blue Shield of Illinois HMO for Therapy

Blue Cross Blue Shield of Illinois HMO for Therapy

Blue Cross Blue Shield of Illinois is the largest health insurance provider in the state, providing coverage for nearly nine million people. It has a track record of 85 years of supporting members’ health and well-being, including their mental health. They offer many different HMO plans.

Do Blue Cross Blue Shield of Illinois HMO plans cover therapy?

Yes, Blue Cross Blue Shield of Illinois provides its members mental health benefits including therapy services through their HMO plans. Using your Blue Cross Blue Shield of Illinois HMO plan for therapy sessions can help you reduce your overall out-of-pocket costs. This is true for members that sign up for Blue Cross Blue Shield of Illinois HMO coverage on the marketplace, as well as those who receive their plans through their employer or their family member’s employer. There are dozens of different HMO plans through Blue Cross Blue Shield of Illinois, so your coverage will depend on your specific plan.

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

To check if your Blue Cross Blue Shield of Illinois HMO plan covers therapy sessions, check out your Summary of Benefits document. The Summary of Benefits document describes what you’ll need to pay yourself for each service, broken down by in-network and out-of-network providers. Look under “If you need mental health, behavioral health, or substance abuse services” in this document and then “Outpatient services” to learn what you’ll be responsible for when it comes to therapy sessions.

You can find this document through your online portal or, if you receive your plan through your employer, from your HR team. Otherwise, you can call the number on the back of your insurance card and request more information on your mental health benefits.

How much does therapy cost with my Blue Cross Blue Shield of Illinois HMO plan?

Blue Cross Blue Shield of Illinois offers many different HMO plans, all with different premiums, deductibles, copays, and coinsurance rates. It’s important to know what your specific plan’s details are before you start working with a therapist to ensure that you aren’t surprised by any costs.

In general, you can expect to pay a copay of $65 when working with an in-network provider. Many Blue Cross Blue Shield of Illinois HMO plans, however, do not provide out-of-network benefits, which means that you’ll be responsible for the entire session fee if you choose to work with a therapist that isn’t on the Blue Cross Blue Shield of Illinois insurance panel.

What types of mental health conditions do Blue Cross Blue Shield of Illinois HMO plans cover?

Blue Cross Blue Shield of Illinois HMO plans provide members with coverage for a wide range of mental health conditions, including but not limited to:

To be eligible for coverage through your Blue Cross Blue Shield of Illinois HMO plan, your therapist may need to provide you with a diagnosis. This is to guide billing and reimbursement. However, if you would rather not receive a diagnosis from your therapist, you might have to privately pay for your sessions without involving Blue Cross Blue Shield of Illinois.

What types of therapy do Blue Cross Blue Shield of Illinois HMO plans cover?

Blue Cross Blue Shield of Illinois HMO plans require that your therapist be a credentialed mental health professional for them to provide coverage for your sessions. Your therapist might be a psychologist, psychiatrist, social worker, licensed professional counselor, nurse practitioner, or any other licensed mental health professional. The type of therapy you receive from your therapist must also have foundations in research, with evidence that points towards its efficacy.

The following are common evidence-based therapy types:

Your therapist might offer a blend of several therapy types, which is often called “integrative” or “eclectic.”

What types of therapy do Blue Cross Blue Shield of Illinois HMO plans NOT cover?

Blue Cross Blue Shield of Illinois HMO plans do not provide coverage for hypnotherapy, biofeedback, or non-evidence-based therapy modalities. This includes life coaching or career counseling, as well as holistic remedies like acupuncture, aromatherapy, or reiki healing. This is not to say that these approaches to improving mental health aren’t helpful, however they lack the scientific rigor that is required for insurance coverage.

Blue Cross Blue Shield of Illinois HMO plans also do not cover therapy services provided by non-licensed providers or sessions that are based on experimental procedures.

Do Blue Cross Blue Shield of Illinois HMO plans cover online therapy?

Yes, you can use your Blue Cross Blue Shield of Illinois HMO plan’s therapy coverage for online sessions. You’ll pay just as much for online sessions as you would for in-person sessions, so you would pay the same copay or coinsurance rates.

Blue Cross Blue Shield of Illinois HMO plans offer its members access to online telehealth sessions around the clock so they can find the care they need no matter the time of day. This is to make healthcare more convenient so it can fit into everyone’s busy schedules.

Do Blue Cross Blue Shield of Illinois HMO plans cover couples therapy?

No, Blue Cross Blue Shield of Illinois HMO does not cover couples therapy. It’s not typical for insurance plans to offer benefits for couples therapy, as a therapist cannot provide a billable diagnosis for more than one person.

However, there are other options to attend couples therapy if that’s still something that you would like to do. If you receive your Blue Cross Blue Shield of Illinois HMO plan through your employer, you might be able to use Employment Assistance Program sessions to engage a couples therapist, or you might be able to ask for a sliding scale from your therapist.

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

Blue Cross Blue Shield of Illinois HMO, as an HMO, requires a referral from your primary doctor before you can see a specialist. To this insurance, therapists are considered specialists, which means that you will need to pay a visit to your primary doctor and get a referral for therapy services before you start receiving benefits from your Blue Cross Blue Shield of Illinois HMO plan. You may need to renew your referral every year to continue working with your therapist and have your sessions covered.

Find vetted therapists who are in-network with Blue Cross Blue Shield of Illinois HMO