Blue Cross Blue Shield (Florida Blue) Mental Health Coverage

Blue Cross Blue Shield Coverage for Mental Health and Addiction Treatment

Blue Cross Blue Shield (BCBS) is one of the largest health insurance companies in the US. BCBS is made up of 34 independent and locally operated BCBSA companies in all 50 states that provide healthcare coverage for more than 100 million Americans.

The Florida subsidiary of BCBS is called Florida Blue. Florida Blue health insurance plans cover both mental health treatment and alcohol drug addiction treatment programs alike. The specific coverage will vary depending on the specific plan you choose, but like all private health insurance providers in the U.S. Blue Cross Blue Shield is required to offer coverage for mental health disorders, including addiction.

This means that if you or your loved one has BCBS health insurance, you may get partial to full coverage for mental health treatment and/or substance abuse treatment costs. If you are wondering what your plan could cover specifically at The Sylvia Brafman Mental Health Center, the easiest way to get a clear answer would be to call SBMHC at: and request verification of benefits. Your admissions coordinator will be happy to explain what your plan may cover here and what your deductible and/or out-of-pocket costs may be in plain language.

Blue Cross Blue Shield Coverage for Mental Health and Addiction Treatment

Different Blue Cross Blue Shield plans offer different levels of coverage. Meaning there will be different percentages of coverage for specific treatment services.

The amount of coverage someone will receive for mental health and/or alcohol and drug treatment programs will also depend on the following:

• State laws and local regulations
• Where you seek treatment (hospital, rehab center)
• Type of treatment needed (inpatient, outpatient, intensive care)

There are many, many different plans offered by BCBS, and the deductibles, copays, out-of-pocket maxes, and services vary extensively from plan to plan. When you have verification of benefits done by SBMHC though, we are able to get a clearer picture of what your BCBS plan can do for you here and we will explain it to you so you can make an informed decision about mental health or addiction treatment for yourself or your loved one.

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.

Paying for Treatment Costs Not Covered by Blue Cross

With all the variables that come with copays, coinsurance percentages, daily fees, and other costs, there is always a possibility your health insurance plans may not cover all the costs associated with treatment. Treatment costs vary and treatment centers like SBMHC submit claims to your Blue Cross Blue Shield on behalf of the patient from week to week and request authorization to provide certain services. This means the precise cost of treatment often cannot be determined until the treatment is completed.

SBMHC will always advocate for our patients’ best interests when dealing with BCBS. We also have no wish to impose financial hardship upon any client or their family. If you have questions or concerns about the possible costs that may not be covered by your BCBS plan, the best place to start is with verification of benefits performed by our staff. This usually takes less than 1 hour and once this and the patient phone interview is complete we can give you a much better idea of what to expect in terms of copays.

We understand that often the cost of treatment is often a deciding factor when someone considers getting help. If you do not have health insurance, prefer not to use (or cannot use it here). We have very reasonable self-pay rates for treatment. We also have a resources page here with links to more information about mental health and addiction treatment including government and charitable organizations.