The majority of Blue Cross Blue Shield plans cover therapy. You may have coverage if you work for a large employer that doesn’t include mental health benefits in its insurance coverage, or your health insurance plan was created before 2014, when the ACA enacted the mental health coverage requirement. There also are other situations when your Blue Cross Blue Shield plan may not cover the specific type of therapy service, or your coverage may not apply until you spend a certain amount on medical services first.
If you choose a therapist in-network with Blue Cross Blue Shield, your therapy sessions likely cost $15 to $50 per session after meeting your deductible. The amount is your copay or the fixed amount you owe at each therapy visit. The deductible is the total amount you need to spend on medical costs in any given year before your health insurance begins to cover the cost of services. Here are examples of what you may see on your summary of benefits 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.
If you choose a therapist who is not in-network with Blue Cross Blue Shield and have a Blue Cross Blue Shield PPO Plan, your therapy session will likely cost between $50-$100 per session or 20%-50% of the total amount that your therapist charges per session. This percentage is called coinsurance. You pay the therapist’s full fee at 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 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 therapy cost is $20 per session, and 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 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. You would owe the therapist’s full fee at the time of the session and not receive reimbursement. 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.
Whether 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 or 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.
To check whether your Blue Cross Blue Shield plan covers therapy, look for the “Outpatient Mental Health” line item on your summary of benefits. 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.
Learn more about Blue Cross Blue Shield behavioral health coverage.
