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Blue Cross Blue Shield Federal Employee Program Mental Health Benefits

A Trusted Provider For 60 Years

2009 Blue Cross Blue Shield Health Benefit: What it means for Federal employees

We’ve been committed to providing quality health care coverage to federal employees, retirees and their families since 1960. Its why 99% of our members stay with us year after year.

Its also because we offer the coverage you need most, including:

  • Free preventive care like your annual physical, flu shots, nutritional counseling and cancer screenings
  • Two free virtual visits with Teladoc® so you can get treatment for minor injuries and illnesses, mental health support, dermatology care and more by phone or video
  • Overseas coverage that keeps you protected when working or traveling outside the U.S.
  • Wellness incentives that reward you for taking charge of your health

You also get access to our Preferred provider network that includes more doctors, hospitals and specialists than any other network. And you never need a referral to see a specialist.

What Kinds Of Therapy Does Blue Cross Blue Shield Not Cover

Like most insurances, it is not typical for Blue Cross Blue Shield to cover services unrelated to a diagnosable mental health condition, such as:

  • Couples counseling – Couples counseling is typically not covered by insurance, because relationship issues, while a significant source of stress, are not considered a diagnosable mental health condition.
  • Life coaching – Life coaching is not covered by insurance because it focuses on achieving personal goals, rather than treating a diagnosable mental health condition.
  • Career coaching – Career coaching is not covered by insurance because it focuses on achieving professional goals, rather than treating a diagnosable mental health condition.

Blue Cross Blue Shield is also unlikely to cover therapy sessions occurring outside the therapy office, because of the greater potential for risk involved. While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance and must be paid for out-of-pocket.

Do I Need To See My Doctor Before Visiting A Blue Cross Blue Shield Therapist

If 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
  • PPO or EPO plan: No, you typically dont need to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.

This referral requirement is also called pre-authorization . Pre-authorization is a process where a health provider, in this case your therapist, must get approval from your insurance company before providing you with care in order for the services to be covered. Your Summary of Benefits should indicate whether you need pre-authorization for outpatient mental health services.

Note: While Blue Cross and Blue Shield is often referenced as one entity, The Blue Cross and Blue Shield Association is in fact composed of 36 locally operated companies. While the following guide provides an overview of Blue Cross Blue Shield therapy coverage, its important to check your specific plan, as each regional affiliate, and within those, each plan, has a unique level of coverage.

Find therapists in-network with Blue Cross Blue Shield

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Can You Buy Standalone Mental Health Insurance

Insurance companies dont sell standalone mental health insurance plans, but many health insurance policies provide coverage for mental health treatment as part of the benefits.

In addition to private and group health insurance, you can also get mental health coverage through Medicaid, an Employee Assistance Program , VA healthcare, therapy apps and some nonprofit organizations.

Blue Cross Blue Shield Association

FEPBlue Health Benefit Plans
Blue Cross Blue Shield Association

Headquarters of one of the member Blues, HCSC, in Chicago.
Founded
BC and BS Foundation on Health Care, BCBSA Services Inc
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Blue Cross Blue Shield Association is a federation, or supraorganization, of 35 separate United States health insurance companies that provide health insurance in the United States to more than 106 million people. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948.

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What To Do If You Think You Need Help

If you need help coping with the challenges in your life right now, it can be helpful to talk about how youre feeling with others. You can find a mental health professional using our online directory here. Use search terms like counseling. You can also narrow the list of providers by type of mental health professional , whether or not they accept new patients and other criteria.

Keep in mind that it might take time for you to find the right mental health professional for your needs, lifestyle and situation. We recommend getting referrals from your friends and your doctor.

Does Blue Cross Blue Shield Cover Therapy

Yes, the vast majority of Blue Cross Blue Shield plans cover therapy.

Health insurances offered through the or through small employers are required by the Affordable Care Act to cover mental health services, and while not required by federal law, the vast majority of large employers also cover mental health services.

Find therapists in-network with Blue Cross Blue Shield

While rare, your Blue Cross Blue Shield plan may not cover therapy services if:

  • You work for a large employer that does not include mental health benefits in its insurance coverage.
  • Your health insurance plan was created before 2014, when the ACAs requirement that health insurance plans cover mental health services was enacted.There are other situations in which your Blue Cross Blue Shield plan may not cover the specific type of therapy service you are seeking, or where your coverage may not apply until you spend a certain amount on medical services first. Learn more about these cases below.

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Behavioral Health Program Overview

BCBSTXs behavioral health care management is integrated with our medical care management program, to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers. This program will help our clinical staff identify members who could benefit from co-management earlier and may result in:

  • Improved outcomes
  • Greater clinical efficiencies
  • Reduced costs over time

Some members* may be referred to other medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.

All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan.

Do All Health Insurance Companies Have To Offer Cover Mental Health

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Health insurance providers arent legally required to offer mental health coverage. The federal parity law instead says that insurers that provide mental health coverage must provide mental health/substance use disorder treatment thats equal to or better than physical health coverage.

For example, under the federal parity law, an insurance company cant charge a $25 copay for an annual checkup with a primary care provider and a $100 copay for a psychologist visit. The law also makes it harder for insurance companies to limit mental health-related appointments annually.

The federal parity law applies to many types of health insurance, including ACA marketplace plans, employer-sponsored coverage , Medicaid and the Childrens Health Insurance Program . Medicare is exempt from the federal parity law.

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Does Blue Cross Blue Shield Cover Couples Counseling

No. While it depends on your specific plan, it is unlikely that Blue Cross Blue Shield will cover couples counseling.

That said, even if your insurance doesn’t directly cover it, you still have options for getting affordable couples counseling. Here are five ways to pay for couples counseling if its not included in your health insurance plan.

The Healthy Endeavors Program

With Healthy Endeavors, you can talk with a trained nurse health coach and get helpful information about your health delivered right to your door, and there’s no extra cost to you. Plus, there’s no obligation you can leave the program at any time.

Call a Nurse Health Coach at: 1-888-392-3506 | Monday – Friday, 8:00 a.m. – 5:00 p.m. EST.

You could be eligible if you have any of these health concerns:

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Continuity And Coordination Of Care

Continuity and coordination of care are important elements of care and as such are monitored through the BCBSMT Quality Improvement Program. Opportunities for improvement are selected across the delivery system, including settings, transitions in care, patient safety, and coordination between medical and behavioral health care. Communication and coordination of care among all Professional Providers participating in a subscriber’s health care are essential to facilitating quality and continuity of care. When the subscriber has signed an authorization to disclose information to a Primary Care Physician , the behavioral health provider should notify the PCP of the initiation and progress of behavioral health services.

Administration Of Behavioral Health Programs

FEP Basic Option Plan

Blue Cross and Blue Shield of Texas administers behavioral health services for members who have behavioral health benefits through a variety of retail, government and group products.

The following plans are administered by BCBSTX Behavioral Health Care Management:

  • Blue Choice PPOSM
  • Blue Cross Medicare Advantage PPOSM
  • Blue EssentialsSM
  • Blue High Performance NetworkSM
  • Blue PremierSM and Blue Premier AccessSM.
  • Employees Retirement System of Texas
  • Federal Employee Program
  • Teacher Retirement System of Texas

The following plans are administered by Magellan Healthcare® for behavioral health services:

  • Blue Advantage HMOSM, Blue Advantage PlusSM HMO
  • MyBlue HealthSM
  • Blue Cross Medicare Advantage HMOSM
  • Medicaid STAR, CHIP and STAR Kids.

In addition, some groups may select other vendors to administer their behavioral health services. For that reason, it is imperative to use Availity® or your preferred vendor to obtain eligibility and benefits, determine who is responsible for administering behavioral health benefits and prior authorization requirements.

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How Do I Check If My Blue Cross Blue Shield Plan Covers Therapy

To check whether your Blue Cross Blue Shield plan covers therapy, look for the Outpatient Mental Health line item on your Summary of Benefits. Therapy is considered a type of outpatient mental health service. You can find your Summary of Benefits by logging into your Blue Cross Blue Shield Member Services portal , calling member services, or checking your employers benefits portal.

Here is an example of what your Blue Cross Blue Shield Summary of Benefits may look like, and where to find the Outpatient Mental Health line item:

If the Outpatient Mental Health line item indicates that these services are not covered, then your health insurance plan does not cover therapy services.

If you cannot find coverage information for Outpatient Mental Health, contact your local Blue Cross Blue Shield Member Services, or if you receive health insurance through your employer, reach out to your employers human resources department.

While your Blue Cross Blue Shield plan likely covers therapy, the extent of coverage and requirements for coverage depend on your particular plan. Read on to learn more.

Federal Employee Plan Enhanced Mental Health Benefits

FEP members’ personal identification cards have a 24-hour toll-free telephone number enabling them to call for referrals to preferred providers, facilities, or for more information about enhanced benefits. We only refer members to preferred providers contracting in a plan’s corresponding directory and will not refer members to non-preferred providers. All providers who have a mental health provider contract with Blue Cross of Idaho are considered preferred providers by the federal government.

Benefits

Inpatient Prior Authorization:

Prior authorization is required for all inpatient stays members failing to get prior authorization may incur financial penalties.

To maximize benefits, Preferred providers should:

  • Obtain prior authorization for inpatient hospital services.

FEP members should:

  • Obtain care from a Blue Cross of Idaho contracting provider.
  • Follow an approved treatment plan.

When a covered family member seeks care from a preferred provider for a covered service, he or she may save money. If a member seeks care from a non-preferred provider, the coinsurance will be higher. For more information about FEP mental health benefits contact customer service.

OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE CARE

Although individual, group, intensive outpatient programs and partial hospitalization programs no longer require prior authorization, Blue Cross of Idaho may review treatment plans for medical necessity and/or case management for members who:

Case Management Services

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What Mental Health Conditions Does Blue Cross Blue Shield Cover

Mental health conditions Blue Cross Blue Shield covers may include:

Note that therapists are required to assign you a diagnosis for the above conditions, as well as share the diagnosis with your health insurer, if you are using insurance benefits to pay for therapy.

If you dont want your insurance company to have access to this information about your mental health, consider out-of-network options instead.

What Types Of Therapy Does Blue Crossblue Shield Cover

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Blue Cross Blue Shield plans cover most types of therapy, including individual therapy and child therapy, as well as different types of therapy approaches, including:

Any therapy type that is evidence-based and utilized for the purposes of diagnosis and treatment of mental health conditions should be covered by Blue Cross Blue Shield plans.

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Blue Cross And Blue Shield Federal Employee Program Expands Preventive Care Maternity Care And Dental Benefits

WASHINGTON Today, the Blue Cross and Blue Shield Government-wide Service Benefit Plan, also known as the Federal Employee Program® , announced it is decreasing dental and vision premiums and expanding benefits for eligible Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program members. These are in addition to the benefits and resources FEP members currently receive, helping them get the most from their medical, dental and vision care.

Among the changes included are enhanced prenatal and postnatal support for members covered under FEPs health plans and expanded BCBS FEP Dental benefits for children. Eligible FEP members will continue to have the opportunity to earn incentives for qualified expenses with their MyBlue® Wellness Card.

This year more than ever, we know everyone is keeping an eye on their health care budget, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association. Thats why weve added new benefits and have enhanced our resources to help current and prospective members get the care they need and deserve, including tools that help them find the right coverage plan and help them find the most affordable care and prescriptions.

Does Medicare Cover Mental Health

Medicare covers mental health, including Medicare Part B, which covers individual therapy, mental health screenings, partial hospitalization and medication management. Medicare Part A, also called hospital coverage, pays for inpatient mental health care. If you have Medicare Part D, most prescription medications for mental health treatment are also covered. Medicare Advantage, also known as Part C, may additionally offer expanded mental health benefits that go beyond Parts A and B.

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How Much Does Therapy Cost With A Blue Cross Blue Shield Plan

If you choose a therapist who is in-network with Blue Cross Blue Shield, your therapy sessions likely cost between $15 – $50 per session, after you meet your deductible. The $15 – $50 amount is your copay, or the fixed amount that you owe at each therapy visit. The deductible is the total amount you need to spend in medical costs in any given year before your health insurance begins to cover the cost of services. Here are examples you may see on your Summary of Benefits under the In-network Outpatient Mental Health category 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 .
  • 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 effective therapy cost is $20/session.
  • 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 effective therapy cost is $24/session.

Behavioral Health Care Management Program

FEP Standard Option Plan

Blue Cross Blue Shield of Montana manages behavioral health services for all members who have behavioral health benefits through a variety of group, government and retail products. Similar behavioral health programs are implemented across product lines but may be modified or enhanced dependent upon the product.

Federal Employees Program members are managed by BCBSMT. FEP members must request prior authorization for Applied Behavior Analysis services but are not required to request prior authorization for any other outpatient behavioral health services including Partial Hospitalization Programs.

Behavioral health care management is integrated with our medical care management program as part of Blue Care Connection® to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers.

This program will help BCBSMT clinical staff identify members who could benefit from co-management earlier, and may result in:

  • Improved outcomes
  • Greater clinical efficiencies
  • Reduced costs over time

Some members* may be referred to other BCC medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.

All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan.

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