Using Blue Cross Blue Shield for mental health therapy: copays, deductibles, and coverage
Using insurance for therapy shouldn’t feel like a second job. Here’s what your Blue Cross Blue Shield plan actually covers for mental health — copays, deductibles, in-network vs. out-of-network, & all the fine print nobody explains upfront.
Sneak peak:
Figuring out if your therapy is covered by Blue Cross Blue Shield (sometimes called Anthem) may feel like attempting to solve a board game with missing pieces. You have no idea what the rules are and every space costs you money. We’re here to help without the superfluous jargon.
In this article, we’ll walk you through what this means for your copay, deductible, and how to find someone in-network with your BCBS plan.
Does BCBS cover therapy?
Most Blue Cross Blue Shield plans do cover therapy and other mental health services. Federal law (the Mental Health Parity & Addiction Equity Act) requires it.1 If your brain happens to be running 27 tabs in the background and 5 of them are related to trying to find an in-network therapist, keep reading!
What your plan covers depends on your specific policy, but many BCBS and Anthem plans include things like:
- Individual therapy
- Family or couples counseling
- Psychiatry visits (medication management)
- Virtual/online therapy
- Anxiety, depression, trauma, stress, ADHD, and other mental health treatment
- Mental health evaluations
Usually, you’ll pay either a copay (a smaller flat fee per session) or coinsurance (which means that both the insurance company and you pay a certain percentage of the cost after reaching your deductible).
The biggest factor affecting your cost: whether your therapist is in-network with Blue Cross Blue Shield. Out-of-network therapy may still be partially covered depending on your plan, but you’ll pay more. Plus, those sessions may not count toward your deductible the same way.
How much does therapy cost with Blue Cross Blue Shield?
This question unfortunately doesn’t have a one-size-fits-all answer. Each insurance plan is different, even within the same company, like Anthem and Blue Cross.
If you haven’t met your deductible yet, you may be responsible for paying the therapist’s full contracted rate per session. (This means the amount that the Blue Cross Blue Shield has assigned for a therapy session to cost.) For example, if the contracted rate is $155, you would pay that amount until your deductible is met. Once the deductible has been reached, your co-insurance would kick in, meaning your insurance begins covering a percentage of each session cost.
Do I need a referral to see a therapist with BCBS or Anthem?
Most Blue Cross Blue Shield plans allow you to see an in-network mental health therapist without a referral from your primary care doctor. Because coverage rules can vary by state, employer, and specific plan, it’s always a good idea to review your benefits or contact BCBS or Anthem directly before scheduling your first appointment.
Does BCBS have a session limit for therapy?
Most Blue Cross Blue Shield plans don’t impose a hard cap on therapy sessions per year. Again, the Mental Health Parity Act prohibits insurers from placing stricter limits on mental health care than they do on medical care. That said, some plans do require periodic check-ins or progress documentation to continue authorizing sessions. If you’re planning to be in therapy long-term, it’s worth asking your insurer: “Is there a session limit for outpatient mental health, or do you require prior authorization after a certain number of visits?” Your therapist can also help you navigate these conversations.
What do I do if BCBS, Anthem Elevance Health denies a therapy claim?
Claim denials are more common than they should be. And they’re often not final! If BCBS or Elevance Health denies a claim for therapy, you have the right to appeal.
Start by reading the denial letter carefully. It should tell you the reason (common ones include: out-of-network provider, missing prior authorization, or a service coded incorrectly). Then:
- Contact your therapist’s billing office. They’ve likely seen this before and can help correct a coding error or submit additional documentation.
- Call the member services number on your card and ask specifically what’s needed to appeal.
- Submit a formal appeal in writing if needed. You can include your therapist’s notes or a letter of medical necessity if the denial was for lack of documentation.
Most states also have an Independent Medical Review process where a third party reviews denied claims. Your denial letter should mention this as an option. Don’t assume the first no is the last word.
How to find a therapist in network with Blue Cross Blue Shield in Kansas or Missouri
The easiest place to start is by logging into your BCBS Member Portal or app and heading to the “Find a Doctor” section. From there, you can search for therapists, counselors, psychologists, etc.
Make sure you filter for:
- In-network
- Accepting new clients
- Virtual or in-person sessions
- Your specific BCBS plan
- Any presenting issues you are seeking therapy for (ADHD, Women’s Issues, Prenatal, etc)
You can also ask your primary care doctor or OB-GYN for recommendations. A lot of doctors already know which therapists commonly take BCBS and which ones people actually like seeing.
Another way to check is by calling the number on the back of your insurance card and asking a few simple questions:
- “What are my therapy benefits within my plan?”
- “Is [Specific Therapist Name] covered under my insurance?”
- “Can you see if this address is covered under my insurance?”
- “How much of my deductible do I have left to pay this year?”
Usually, an insurance representative can look up if your doctor or therapist is in-network by looking up their name, the name of the facility, or the address of the facility.
Perinatal therapists who accept BCBS and Anthem
A helpful place to begin is the Postpartum Support International Directory, which allows you to search for therapists by specialty, location, and insurance. This can be a straightforward way to find someone who truly understands the perinatal experience and is within your network.
If you already have a primary care doctor, OB-GYN, doula, or midwife, you may also ask them for recommendations. Providers in your care circle often know trusted therapists in the community and can help point you in the right direction based on your insurance and your needs.
Kansas therapists in network with BCBS
If you are located in Kansas or Missouri, our therapists here at Holding New Therapy are in network with all states for Blue Cross Blue Shield, including Blue Cross Blue Shield Kansas, Blue Cross Blue Shield KC, federal Blue Cross Blue Shield, and Anthem plans! Learn more about our therapists here.
Through virtual perinatal therapy, we can work with people in Wichita, Kansas City, Overland Park, Lawrence, Topeka, Manhattan, Salina, Hutchinson, and throughout both states of Kansas and Missouri. You can sit on your couch, or in your car between appointments, or in your bed at 38 weeks pregnant with your dog on your feet. Come exactly as you are.
If you’re looking for in network mental health care for Blue Cross Blue Shield, or searching postpartum therapy near me, we’re here for you.
Let’s start slowly. You don’t have to have all the words ready.
Takeaway
- Blue Cross Blue Shield is required by federal law to cover mental health therapy. The specifics depend on your plan, but coverage exists!
- Whether you pay a copay or coinsurance depends on your plan type and whether you’ve met your deductible.
- In-network therapy is almost always more affordable than out-of-network. Use your member portal or call the number on your card to confirm before your first session. Your prospective therapist can also help you with this if you ask!
- Most BCBS plans cover virtual therapy at the same rate as in-person.
- Postpartum, prenatal, and perinatal mental health therapy are covered under behavioral health benefits.
- If you’re in Kansas or Missouri and looking for a BCBS-accepting perinatal therapist, our team at Holding New Therapy is in-network and here when you’re ready.
FAQs about BCBS mental health deductible
Anthem (now officially called Elevance Health) is the company that operates Blue Cross Blue Shield plans in certain states, including parts of the Midwest. If your card says Anthem, your BCBS benefits work the same way.
Your copay is just the set amount you pay each time you go to therapy or the doctor’s office (if your plan has one). It’s usually something like $20, $40, or $60 per session, and your insurance covers the rest (as long as you’re seeing someone in-network).
To find it, start with looking directly on your insurance card. If it’s not located there, you can log into your BCBS (or Anthem) member portal or app. Look for sections that say things like “Benefits,” “Plan Details,” or “Mental Health / Behavioral Health.”
If you see a flat number listed, that’s your copay. If instead you see something like 20% or 30%, that means you have coinsurance, which is a percentage of the session cost instead of a set amount.
And if you can’t find anything (which happens a lot) or have further questions, call the number on the back of your card and ask, “What’s my copay for in-network therapy sessions?”
One more to mention that might catch you off guard, If you haven’t met your deductible yet, you might not use your copay right away. Instead, you could be paying the full contracted rate until your deductible is met. Again, this is all insurance legalese and an insurance representative or your desired therapist can help make sense of your specific plan information for you.
A deductible is the amount you pay out of pocket for healthcare services before your insurance starts covering costs. For example, if your deductible is $1,000, you’ll typically pay for services yourself until you’ve spent that amount. Some services, like preventive care, may be covered before you meet your deductible depending on your insurance plan.
Coinsurance is the percentage of healthcare costs you share with your insurance company after you meet your deductible. For example, if your plan has 20% coinsurance, you pay 20% of the cost of a covered service while your insurance pays the remaining 80%. Coinsurance continues until you reach your plan’s out-of-pocket maximum.
For example, if your coinsurance is 20% and a therapy session costs $150, you would pay about $30 and your insurance would cover the rest.
In-network means your therapist has a contract with BCBS and has agreed to their reimbursement rates. Your copay or coinsurance applies, and your sessions count toward your deductible.
Out-of-network means the therapist doesn’t have that contract. You may still have partial coverage as many PPO plans include out-of-network benefits, but you’ll typically pay more out of pocket. With this, you may need to submit claims yourself for reimbursement with itemized receipts called superbills. HMO plans usually don’t cover out-of-network therapy at all, except in emergencies.
Since 2020, BCBS plans have broadly expanded telehealth coverage. Most plans now cover virtual therapy sessions at the same rate as in-person. This means your regular copay applies, not a different telehealth rate.
Postpartum depression, prenatal anxiety, pregnancy loss, and other perinatal mental health concerns are covered under behavioral health benefits — the same as any other outpatient therapy. If your therapist specializes in perinatal mental health and is in-network with BCBS, your plan covers it.
Once you’ve met your deductible, you move to just paying your copay or coinsurance per session. Your copay is a flat dollar amount (like $30). Coinsurance is a percentage (like 20% of the session’s contracted rate). Your plan will have one or the other. Your benefits summary will tell you which.
Your out-of-pocket maximum is the most you’ll pay for covered services in a plan year. Once you hit that number — through a combination of your deductible, copays, & coinsurance — your insurance covers 100% of covered services for the rest of the year.
For therapy, this means that if you’ve been paying out of pocket for a while (especially if you hit a high deductible early in the year), there may be a point where your sessions become fully covered. It’s one of the less-talked-about parts of insurance that can actually work in your favor. Your Member Portal or benefits summary will list your out-of-pocket maximum under plan details.
Holding New Therapy is a perinatal mental health practice licensed in Kansas & Missouri. Our team specializes exclusively in pregnancy, postpartum, infertility, loss, birth trauma, & the complicated middle of reproductive mental health — including body image & disordered eating during the perinatal period. This post is for informational purposes & is not a substitute for individualized clinical care. If you are in crisis or believe you are at risk of harming yourself, please call or text 988.
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We’re committed to making therapy for new parents accessible. All of our sessions are held virtually to reduce barriers like transportation, childcare, finances, location, & mobility needs. If there’s anything we can do to better support your access to care (communication preferences, tech accommodations, website adjustments, etc), please let us know at admin@holdingnewtherapy.com.
