Using Blue Cross Blue Shield for Therapy at Mountainside

If your card says Anthem Blue Cross and Blue Shield, read our Anthem page instead. This page is for out-of-state Blue plans and FEP Blue.

Which Blue plan is on your card?

Each Blue Cross Blue Shield company sets its own benefits. The company printed on your card (for example, an employer's plan from Texas, Illinois or Florida) is your "home plan." Its rules decide whether out-of-network therapy is covered, and it is where you send your claims.

Federal employees: FEP Blue

The Federal Employee Program works differently from other Blue plans:

• FEP Blue Standard covers non-preferred (out-of-network) providers at a lower level than preferred ones.
• FEP Blue Basic and FEP Blue Focus generally do not pay for non-preferred providers, apart from limited exceptions such as emergencies.

Benefits change each year, so check the current FEP Blue brochure for your option.

Does your Blue Cross plan pay for out-of-network therapy?

It depends on the plan type, not just the company name on the card. Your plan's Summary of Benefits and Coverage lists an "out-of-network" column; if that column says "not covered" for outpatient mental health, the plan will not reimburse you.

• PPO and POS plans usually include out-of-network benefits, with a separate deductible and a lower reimbursement rate than in-network care.
• HMO and EPO plans usually pay nothing out-of-network except in emergencies.
• Medicare, Medicare Advantage and Health First Colorado (Medicaid) follow different rules. Please ask us before booking.

Federal parity law means that if a plan pays for out-of-network medical care, it generally has to offer comparable out-of-network mental health coverage.

How reimbursement is worked out

Blue Cross does not pay a percentage of our fee. It pays a percentage of the amount your plan allows for the service, which can be lower than what we charge. Any out-of-network deductible has to be met first. The gap between our fee and the allowed amount is yours to pay.

Until you meet the out-of-network deductible, each superbill counts toward the deductible but you get nothing back yet. That is why it pays to ask about the deductible first.

Questions to ask Blue Cross before your first session

Call the member services number on the back of your card and ask for behavioral health benefits. Write down the date, the representative's name and the call reference number.

• Do I have out-of-network benefits for outpatient mental health care?
• What is my out-of-network deductible, and how much of it have I met this year?
• What percentage of the allowed amount do you pay, and what is the allowed amount for CPT code 90834 (a 45-minute session)? If you are joining a DBT skills group, ask about 90853 (group therapy) too.
• Is there a limit on the number of visits, or do you need prior authorization?
• How do I submit a claim, and what is the deadline for filing it?

Sending your superbill to Blue Cross

1. Pay for your session. We accept HSA and FSA cards.
2. We give you a superbill with the clinician's credentials and NPI number, dates of service, diagnosis and procedure codes, and the amount you paid.
3. Submit it to Blue Cross using the member website or claim form of the Blue company on your card. If you are not sure where to send it, call the member services number on the back of the card.
4. Blue Cross sends any reimbursement to you, along with an explanation of benefits. Keep it for your records.

Submitting each month keeps you well within filing deadlines and makes it easier to track your deductible.

Why many clients pay privately instead

Using out-of-network benefits is entirely your choice, and plenty of our clients with insurance decide not to file claims at all. Our guides compare in-network, out-of-network and self-pay therapy and explain Good Faith Estimates, the written cost estimate self-pay clients can ask for.

• Privacy. When you do not file a claim, no diagnosis goes to your insurer. A superbill has to include a diagnosis code.
• No plan reviews. Your treatment does not have to meet a plan's medical-necessity rules or visit limits.
• Clear costs. You know the fee before every session, with no surprise bills later.
• Pre-tax money. Therapy is generally an eligible expense for HSA and FSA funds.

Your exact rate depends on the clinician and is confirmed in your free consultation. If you pay without using insurance, you also have the right to a Good Faith Estimate of your costs before care begins. Ask us for one.

Frequently asked questions

Other insurance plans

• Using Aetna Insurance for Therapy at Mountainside
• Using Cigna Insurance for Therapy at Mountainside
• Using Anthem Blue Cross Blue Shield for Therapy at Mountainside
• Therapy cost, insurance and pricing

This page is general information about insurance, not a promise of coverage. Benefits differ by plan and change each year; only your insurer can confirm what your plan pays. Mountainside is not affiliated with any insurer named here.