Blue Cross Blue Shield Coverage for Mental Health Therapy Treatment in Florida

Mental Health Programs Covered by Blue Cross Blue Shield Insurance

Blue Cross Blue Shield Insurance recognizes the critical importance of mental health care in overall well-being. Their comprehensive coverage includes a range of programs and services aimed at providing mental health support, treatment, and therapy for those facing mental health challenges.

Florida Blue covers a range of mental health treatment options, from therapy sessions to medication management, BCBS is committed to ensuring its members have access to the necessary resources for optimal psychological health and well-being, ultimately leading to a more balanced, fulfilling life.

BCBS Coverage for Partial Hospitalization Programs

A Partial Hospitalization Program (PHP) is a structured form of mental health treatment that provides intensive, short-term care for individuals requiring extensive therapy without 24-hour inpatient care. Patients participate in daytime therapy and counseling while returning home in the evenings to maintain daily routines.

BCBS health insurance usually covers PHP as part of its mental health benefits, offering financial support to individuals who require short-term, intensive mental health treatment without total inpatient care. However, coverage specifics may vary depending on the policy, individual circumstances, and other factors, so reviewing your plan for details is essential.

BCBS Coverage for Intensive Outpatient Program

An Intensive Outpatient Program (IOP) is a structured treatment option for individuals struggling with mental health or substance use disorders. It offers therapy, counseling, and support sessions multiple times weekly, allowing patients to continue living at home. Blue Cross Blue Shield Insurance typically covers IOP services as part of their comprehensive mental health coverage.

BCBS Coverage for Outpatient Program

In an outpatient program, patients receive medical services, therapy, or counseling without staying overnight in a medical facility. Typically, patients can maintain their daily routines and return home after each session. Blue Cross Blue Shield Insurance often covers outpatient programs, including medical visits, therapy sessions, and mental health services.

Treatment for Bipolar Disorder and Cyclothymia

Bipolar disorder is a mental health condition that causes extreme mood swings, ranging from manic highs to depressive lows. Cyclothymia is a milder form of bipolar disorder with less severe mood changes. Both mood disorders significantly impact a person’s emotions, energy levels, and daily life, requiring medical and therapeutic intervention for management and stability.

BCBS generally covers these mental health disorders as part of their mental health benefits, ensuring that individuals with these psychiatric conditions have access to treatment and support. However, the coverage specifics may vary.

Treatment for Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a complex mental health condition defined by pervasive patterns of instability in emotions, self-image, and interpersonal relationships. Individuals with BPD often experience intense mood swings, impulsivity, unstable self-esteem, and difficulty maintaining healthy relationships.

BPD can significantly impact a person’s daily life, relationships, and overall well-being, but with appropriate therapy and treatment, individuals can learn to manage their symptoms and lead fulfilling lives. Blue Cross Blue Shield Insurance typically covers the diagnosis and treatment of BPD. This coverage may include psychotherapy, medication management, and other psychotherapy techniques and interventions.

Treatment for Anxiety Disorder

Anxiety is a common mental health condition characterized by excessive worry, fear, and apprehension about future events or situations. Individuals with anxiety often experience physical symptoms like restlessness, rapid heartbeat, sweating, and muscle tension. Anxiety can significantly interfere with daily functioning, affecting work, relationships, and overall quality of life.

Blue Cross Blue Shield Insurance typically covers anxiety treatment. BCBS coverage may include psychotherapy, cognitive-behavioral therapy (CBT), medication management, and other evidence-based interventions to reduce symptoms and improve overall well-being.

Treatment for Depression

Depression is a common mental illness characterized by persistent feelings of sadness, hopelessness, and lack of interest or pleasure in activities once enjoyed. Depression symptoms often include changes in appetite and sleep patterns, low energy, and difficulty concentrating that can disrupt daily functioning, impair relationships, and even lead to suicidal thoughts if left untreated.

Blue Cross Blue Shield Insurance typically covers treatment for depression. This coverage may encompass preventive care benefits, therapy sessions, prescription medications, and other evidence-based treatments that aim to alleviate depression symptoms, helping individuals regain their mental and emotional well-being.

Treatment for Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, characterized by symptoms like intrusive flashbacks, nightmares, severe anxiety, and emotional numbness. Individuals with PTSD may also exhibit hypervigilance and avoid situations that remind them of the traumatic incident. PTSD can significantly impair one’s daily life and well-being.

Fortunately, BCBS typically provides coverage for PTSD treatment, encompassing therapy, medication, and other evidence-based interventions to provide individuals with coping strategies for stress management. This coverage underscores BCBS’s commitment to mental health advocacy.

How To Check My BCBS health Insurance Coverage levels

To review your BCBS health insurance coverage levels, you can call 877-958-9212. Our helpful team of patient advocates will assist you by contacting BCBS member services to verify your coverage details. After that, we’ll go through your policy with you and provide you with a clear understanding of the treatment and program options available to you.

Please note that all information you provide or discuss with us is confidential.

How Many Times Will BCBS Pay for Rehab?

BCBS may cover multiple rounds of rehab. However, this can vary based on several factors, including your particular policy, the type of treatment required, and the medical necessity determined by the insurance company. BCBS provides various plans with different coverage options, so review the details of your specific plan to understand the limits and benefits associated with rehab.

Blue Cross Insurance Plan Tiers

There are four different levels of Blue Cross plans. They simply offer various copays, deductible amounts, and premiums depending on your household’s needs. All four of them (by law) must offer some coverage for both mental health and addiction treatment.

The four levels of plans include:

1. Bronze: The Bronze plans have lower monthly premiums and higher deductibles. They often have higher copay amounts for certain treatment services. This makes them the most affordable BCBS plans, but they can mean your portion of treatment costs will be significantly higher depending on what services you need.
2. Silver: The Silver plans fall right in the middle price-wise between the Bronze and Gold plans. Making it a mid-range monthly premium and deductible decreased copay amounts from the Bronze plan but not as low as the Gold and Platinum plans.
3. Gold: BCBS Gold plans usually have higher monthly premiums and lower deductibles. So the monthly cost will be higher, but your portion of the bill for treatment will be smaller. People with BCBS Gold plans usually have lower overall costs for treatment services, but it depends.
4. Platinum: Platinum plans tend to have the highest monthly premium cost and lowest deductibles of all the Blue Cross Blue Shield health insurance tiers. Plans will vary on copay amounts but they will almost always have a significantly lower co-pay amount than the other plans. This means a higher monthly bill, but much more of the addiction or mental health treatment services are covered by insurance.

Mental Health/Substance Abuse Treatment and Blue Cross Frequently Asked Questions (FAQ)

Q: Do Treatment Centers Need To Be In-Network With BCBS?

A: Some BCBS plans, known as HMOs (Health Maintenance Organizations), will require the rehab center to be in-network to provide any coverage. PPOs (Preferred Provider Organizations) plans favor the patient and give you more flexibility to choose where you want to go for mental health treatment

Q: Which Rehab Centers Accept Blue Cross Blue Shield Insurance?

A: Most private mental health and substance abuse treatment centers, like Sylvia Brafman, accept Blue Cross Blue Shield insurance plans for mental health and/or addiction treatment, but it’s always best to start with verification of benefits from the rehab center to be sure.

Q: Does Blue Cross Blue Shield Cover The Cost Of Addiction and/or Mental Health Treatment?

A: Blue Cross Blue Shield is required by federal law to offer coverage for both addiction and mental health treatment on all of its health insurance plans. How much of the cost they will cover depends on your plan’s deductibles and copays. The type of treatment you require and the length of stay are also determining factors in how much they will cover the total bill.

Q: Does Blue Cross Blue Shield Cover The Cost Of Partial Hospitalization Programs?

A: Yes, BCBS plans offer coverage for PHP treatment. Treatment at the PHP level of care is also less expensive per day than residential or inpatient treatment which may reduce your overall cost for treatment while still allowing you to get a full day (6 hours) of treatment 5 times a week if/when there isn’t a clinical need for inpatient treatment and overnight stays.

Q: Does Blue Cross Blue Shield Cover The Cost Of Intensive Outpatient Programs?

A: BCBS plans also offer coverage for IOP treatment. Treatment at the IOP level of care is also less expensive per day than PHP treatment which may reduce your overall cost for treatment, however, it also entails much fewer total hours of treatment each week so it isn’t usually the right place to begin treatment for most people. However, IOP is an excellent follow-up after completing PHP treatment.

Q: Does Blue Cross Blue Shield Cover The Cost Of Medication Assisted Treatment (MAT) like Suboxone?

A: Suboxone – a medication used in opioid treatment – is frequently used in medication-assisted treatment (MAT) programs. Because Suboxone is a prescription drug, it will fall under the pharmacy benefits of your insurance plans. Your copay for Suboxone or any other MAT medication would be determined by your pharmacy co-pay in your prescription drug plan.

Exploring the Sunshine State and its Southern Cities

South Florida is home to various well-known cities, each with unique attractions. Miami is a bustling hub of culture, boasting a vibrant nightlife scene, world-renowned dining options, and iconic Art Deco architecture. The city is a melting pot, with a strong Latin influence, beautiful beaches, and an annual Art Basel event that attracts art enthusiasts worldwide.

Hollywood, on the other hand, offers a more laid-back atmosphere, with its picturesque beachfront and the famous Hollywood Beach Boardwalk. Fort Lauderdale, known as the "Venice of America," has a complex canal system, making it a paradise for boaters and a popular destination for yachting enthusiasts. Pompano Beach is excellent for fishing and water sports, while Boca Raton is known for its luxurious resorts, golf courses, and high-end shopping, making it a haven for those seeking an exclusive lifestyle in South Florida.

Rehab and Mental Health Statistics in Florida

In Florida, a significant issue is the widespread unmet mental health needs, primarily due to financial limitations. Nearly half of the state's adults facing mental health challenges do not receive the essential care they require. The situation is grim, with 3,567 lives lost to suicide in 2020 and a troubling 610,000 adults who contemplated suicide the same year.

These concerning statistics have far-reaching consequences. Roughly 40% of adult inmates have a history of mental illness, and high school students grappling with depression are more than twice as likely to discontinue their education. Shockingly, 64.2% of depressed adolescents in Florida received no care in the past year. Furthermore, 6,387,811 residents lack access to sufficient mental health professionals in their communities.

• Since 2015, Florida's hospitalization rate for mental health disorders has risen slightly from 1,022.9 to 1,026.6 per 100,000 people in 2019.¹
• In Florida, the percentage of adults who have experienced depression increased from 14.2% in 2016 to 17.7% in 2019, while the US rate was 19.9% in 2019.
• In 2019, there were 3,427 suicides among Florida residents, making suicide the 8th leading cause of death in the state.
• As of 2021, 13.1% of people in Florida are uninsured.²
• There are 27,487 homeless people in Florida, and 1 in 6 has a serious mental illness (SMI).
• In May 2022, 23.6% of Florida adults with anxiety or depression symptoms did not receive counseling in the past four weeks, compared to the national average of 28.2%.³
• Between 2008-2010 and 2017-2019, the percentage of young adults aged 18-25 with serious mental illness (SMI) in Florida increased annually on average.⁴
• From 2017 to 2019, the average prevalence of serious mental illness (SMI) in Florida was 4.1%, lower than the regional and national averages.
• From 2017 to 2019, 38.9% (1.1 million) of people with any mental illness (AMI) in Florida used mental health services, which is lower than the regional and national averages.
• Florida had the third-highest rate of opioid-related overdose deaths in the United States in 2019, with 22.1 deaths per 100,000 people, according to the National Institute on Drug Abuse (NIDA).⁵

Sources

1. “Focus on Behavioral Health.” FL Health Charts, Apr. 2021, www.flhealthcharts.gov/charts/documents/FOCUSbehavioral2021.pdf.
2. “Mental Health in Florida.” National Alliance on Mental Illness (NAMI), Feb. 2021, www.nami.org/NAMI/media/NAMI-Media/StateFactSheets/FloridaStateFactSheet.pdf.
3. “Mental Health and Substance Use State Fact Sheets - KFF.” KFF, 20 Mar. 2023, www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/florida.
4. “Behavioral Health Barometer : Florida, Volume 6.” Substance Abuse and Mental Health Services Administration, 2020, www.samhsa.gov/data/sites/default/files/reports/rpt32826/Florida-BH-Barometer_Volume6.pdf.
5. “Annual Report Fiscal Year 2020-2021.” Florida Department of Health Division of Medical Quality Assurance Prescription Drug Monitoring Program, 2021, www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/_documents/annual-report-2021.pdf.