Does Blue Cross Blue Shield (BCBS) Cover Mental Health Treatment?


Most Blue Cross Blue Shield (BCBS) health insurance policies cover the cost of mental health treatment. This coverage became fairly standard across BCBS plans beginning in 2014 with the passage of the Affordable Care Act. Policies purchased prior to 2014 may not offer as many benefits for mental and behavioral health as post-ACA policies. Notably, evidence-based treatment is covered, such as therapeutic services and psychoanalyses. Services rendered out of a therapeutic setting are typically not covered, such as out-of-office systematic desensitization or exposure treatment led by a therapist to treat certain phobia.

Covered Services

Most network plans from BCBS cover applied behavior analysis, residential treatment, emergency mental health care, group therapy, and other mental health services. Still, it is important to note that BCBS plans may have stipulations that must be met in order for coverage to be provided. What’s more, employers have the ability to customize the benefits that they offer, and they can also determine what the insured must do in order to access these benefits. For this reason, it is important to check your individual policy to make sure you’re covered.

You will need to choose a mental health provider in the BCBS network in order to be covered. Some services available may also include case management services, consultations and outpatient services.

Deductibles and Copays

With most health insurance plans, including plans from Blue Cross Blue Shield, you must first meet your deductible prior to receiving coverage. For example, if your policy has a $500 deductible, then you are responsible for the first $500 in care. You may also need to pay a copay for each visit or treatment. For instance, your policy may require you to pay a certain percentage of your treatment costs per visit or a set amount per visit or service, such as $40. Check your Blue Cross Blue Shield policy details to determine if you have a deductible and if you must pay a copayment with your mental health services.

Checking BCBS Coverage

Insured policyholders can check on their individual coverage levels by logging into their Blue Cross Blue Shield member accounts. This involves accessing the Blue Cross Blue Shield website or its mobile app. Once logged in, policyholders should select Go to My Coverage, and then tap on Medical, select the What’s Covered option, and then click on Find Behavioral Health Care, Mental Health Care and Substance Use Treatment.

After accessing the services available for behavioral health and substance abuse services, policyholders can find information regarding plan requirements necessary to obtain services, which services their individual plan offers, how much they must pay for services (such as copays and deductibles) and how much their plans pay for covered services.

BCBS Medicare Coverage

For policyholders who have Medicare coverage through Blue Cross Blue Shield, mental health services are covered. There is no need for policy holders to get a referral for mental health care from their primary care providers if they have coverage under a BCN Advantage plan. Visits are typically covered with copayments, and members with original Medicare are assessed a 20 percent copayment with every visit to a mental health care provider. Blue Cross Blue Shield encourages all policyholders to use their Find a Doctor tool to help them find qualified mental health care providers.

Alter Behavior Health Can Help

While most Blue Cross Blue Shield health insurance policies, including Medicare plans, offer some level of therapeutic coverage for policyholders and their insured spouses and children, not all do. Coverage levels vary from plan to plan, and coverage may be subject to a deductible prior to receiving covered services. In addition, policyholders may have to pay a copay in order to receive services.

Alter Behavioral Health in Orange County offers professional care from licensed providers to deal with primary mental health disorders. Reach out to Alter Behavioral Health for caring, compassionate help for all mental health issues.