Inpatient And Alternative Levels Of Care
prior authorization is required for all inpatient, residential treatment center and partial hospitalization admissions.
Elective or non-emergency hospital admissions must be preauthorized prior to admission or within 24 hours of the admission or next business day of an emergency admission
Residential Treatment Center benefits are generally excluded from most plans however, there are some employer groups who have elected to cover this service. To determine if RTC services are covered, call the appropriate number on the back of the member’s ID card
How To Find Mental Health Services Near Me In Tennessee
With Athena Care, gaining access to mental health assessments and treatments in Tennessee has never been easier. A care coordinator can assist you at one of our various Tennessee locations.
When choosing a mental health provider, keep the following in mind:
- Education, training, license, and years of experience
- Specialties and services offered
- Insurance companies they work with
Also, dont be afraid to ask questions.
Athena Care mental health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m.
Here youll find a list of practitioners organized by city, along with information about their backgrounds and specialties.
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.
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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.
Tips For Choosing An Outpatient Behavioral Health Provider
Mental Health professionals can be highly specialized. Some have general practices while others concentrate on a specific area of mental health, such as addiction or geriatrics. They may provide individual, group or couple/family therapy. Not all outpatient practitioners specialize in treating certain conditions or age groups, such as children or adolescents. Once you have some names of participating private practitioners or facilities, contact the providers to obtain more information about the services they provide.
You should consider the following before scheduling an appointment with the provider:
- Does the provider participate with my health insurance?
- Is the service a covered benefit?
- Does the provider have experience treating my mental health condition?
- Does the provider specialize in treating certain age groups, such as children, adolescents, or seniors?
- Is the provider accepting new patients?
- What hours is the provider available for appointments?
- What types of therapy does the provider offer?
After meeting with the provider, it’s ok if you feel a little uncomfortable during the first few sessions. Sharing personal information can be difficult and it may take some time to build trust. However it’s important to eventually feel comfortable with your provider. If you are still uncomfortable after several sessions, don’t hesitate to try a different provider.
As a patient, you should expect:
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Phone + Online Support
Help for substance use disorder
Drinking and drug use including legal drugs and medications has increased since the pandemic began. If you think you or a loved one may need support, please call one of these numbers. We can help you find a behavioral health specialist or treatment center, depending on your needs.
- Blue Cross PPO, answered by New Directions:
- Blue Care Network HMO:
- Medicare Plus Blue PPO:
- Blue Care Network Advantage HMO:
You can see which plan you have on your Blue Cross ID card.
Online therapy with Blue Cross Online Visits
You can save yourself a commute and have a teletherapy session from the comfort of your home. All you need is a little time and a smartphone or computer. You can:
- See a therapist or U.S. board-certified psychiatrist
- Have a face-to-face, online visit from anywhere
- Browse profiles, credentials and patient reviews
- Get care for your whole family, children included
Costs can vary, so check your coverage before you sign up. Simply log in to your Blue Cross Blue Shield of Michigan account and search online visits from the Whats Covered tab. Or, see how your member account can help you find other therapists who offer online support. Keep scrolling to learn more.
Ready to sign up for Blue Cross Online Visits? Enter your subscriber ID, formerly known as the enrollee ID when you sign up, so your coverage applies correctly. You can find it on the front of your Blue Cross ID card.
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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What Types Of Services And Providers Are Available
Outpatient care
- Psychiatrist A medical doctor who specializes in preventing, diagnosing, and treating mental illness. Psychiatrists can prescribe psychiatric medications.
- Psychologist A licensed, mental health professional trained to work with mild or severe psychological issues. Psychologists do not prescribe medications.
- Counselor A licensed, mental health professional, such as a social worker, mental health counselor, or marriage and family therapist, who evaluates and treats common life stressors, and mild to moderate mood disorders. Counselors do not prescribe medications.
- Typically three days per week, three to four hours per day, for four to six weeks. Most are structured so people can continue their normal daily routines.
- Combination of individual and group therapy and may include psychiatrist evaluation and medication management.
- Recommended for people who are experiencing emotional and behavioral problems and would benefit from learning how to manage their symptoms and issues in a structured environment.
- Typically five days a week, five hours a day
- Combination of individual and group therapy and often includes evaluation by a psychiatrist
- Recommended for people who require more intensive treatment than traditional outpatient care, are experiencing serious emotional and behavioral problems, or are at risk for hospitalization as well as for treatment following inpatient hospitalization
Inpatient care
Specialized programs
Home- and community-based services
How Do I Find The Care I Need
BCBSRI covers a comprehensive list of services and benefits to meet the needs of our members with mental health and substance use disorder issues. These resources can help provideor connect you withtreatment and support.
Your primary care provider
BCBSRI does not require our members to get a referral for outpatient counseling and medication services. However, if you or someone you care for may benefit from psychotherapy or another form of mental health and/or substance use disorder treatment, the best place to start is with a primary care provider . Discuss symptoms with your PCP and ask for a recommendation.
Case management
Independently licensed mental health and substance use disorder professionals work with you and coordinate care with your team of providers to get you access to the resources and services you need. They also review any medications you are taking and make sure you understand what they are for and how to take them. Call 1-800-274-2958.
BCBSRI Doctors Online
BCBSRI Doctors Online makes it easy to visit a therapist or psychiatrist on your smartphone, tablet, or computer. Talk with a healthcare professional from your home, office, or wherever you are. Search BCBSRI Drs. Online from the App Store or * or visit drs-online.com.
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Mental And Behavioral Health Care Team
At no cost to you, a team of nurses that collaborate and coordinate care for you and your familys mental and behavioral health needs:
- Navigate the mental and behavioral health system to find the right care and resources through your health plan benefits, group benefits like Employee Assistance Programs and other community resources
- Holistic approach to care nurses that can help with lifestyle changes, stress management techniques and coping strategies along with addressing any other health conditions like diabetes, heart and lung diseases, and many more
- Assesses social determinants of health to ensure you can get the care you need when you need it
- Advocates for you and works with your primary care physician
Signing up is easy!
How To Choose The Best Mental Health Insurance
Many health insurance plans cover mental health, according to AHIP, a national association that represents the health insurance industry. In an AHIP study of insured Americans:
- 6 in 10 respondents said their mental health treatment was fully covered by their health insurance policy
- 3 in 4 said that it was easy to find the support they needed
To find the best mental health insurance for you, consider these factors:
- Network size: Insurance companies that contract with many mental health providers, especially in your area, will give you the biggest selection of professionals and facilities where you can get care.
- Virtual appointments: The best mental health insurance companies typically offer telehealth and virtual appointments, so you can receive mental health treatment anywhere.
- Covered services: When comparing providers, pay attention to the services each plan covers. Consider choosing a plan that provides a good mix of inpatient and outpatient services for the most comprehensive coverage.
- Referrals: Some health insurance plans, such as HMOs, require referrals from a primary care provider, while others dont demand a referral. If you want to manage your own mental health care, look for plans that dont require a referral for mental health visits, for instance a PPO health plan.
- Free resources: Some health insurance providers offer free mental health resources for members, like Kaiser Permanente, which provides free access to the Ginger app.
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New Directions Behavioral Health
We work with New Directions Behavioral Health to provide behavioral health services and resources to help you get the care you need, when you need it no matter what challenges youre facing.
Get support for:
- Autism management
Talk to your HR administrator to learn more about whether your company has additional behavioral health benefits as part of your employer-sponsored health plan.
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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Alter Behavior Health Can Help
While most Blue Cross Blue Shield health insurance policies, including Medicare plans, offer some level of therapeutic coverage for policyholders and their insured spouses and children, not all do. Coverage levels vary from plan to plan, and coverage may be subject to a deductible prior to receiving covered services. In addition, policyholders may have to pay a copay in order to receive services.
Alter Behavioral Health in Orange County offers professional care from licensed providers to deal with primary mental health disorders. Reach out to Alter Behavioral Health for caring, compassionate help for all mental health issues.
Behavioral Health Program Components:
- Care/Utilization Management
- Inpatient Management for inpatient, partial hospitalization, residential treatment center services, and some outpatient behavioral health care services.
- Outpatient Management for members who have outpatient management as part of their behavioral health benefit plan through BCBSMT. The BH Outpatient Program includes management of intensive and some routine outpatient services.
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How Much Do Mental Health Services & Testing Cost
Costs can vary depending on your specific Blue Cross Blue Shield mental health coverage and personalized treatment needs. The following are average costs for therapy, though they may vary by location and other variables and may not reflect the actual cost of treatment or what you may actually pay.
For example, In the United States, the typical cost of psychotherapy ranges from $100 to $20010 a session, dependent upon the state and the length of the session. With health insurance, youll most likely have a co-pay that can range from a few dollars to $50 or more a session.
Cognitive Behavioral Therapy sessions are typically 45+ minutes long and cost between $100 and $200 per session, while Dialectical Behavioral Therapy usually consists of a weekly individual therapy session, a weekly group therapy session, and weekly phone conversations. DBT costs vary depending on the type of services rendered.
Such factors, like whether the therapist is in-network or out of network, can influence this out-of-pocket cost.
Even with insurance, you will normally have to pay some or all of your medical expenditures until your total medical expenses for the year reach the deductible. Depending on your plan, you may be required to pay a co-pay or coinsurance for each treatment.
The Right Care At The Right Time
Behavioral health concerns are related to physical health problems, and they often occur together. Were working with your PCP and behavioral health professionals to treat your whole self by making information sharing about you easier.
One of the ways we do this is by giving PCPs tools that can identify the behavioral health services you need at the right time. The right service when it’s right for you might mean your PCP addresses your concerns in the office, refers you to a community-based therapist or psychiatrist, or even connects you to virtual therapy you can access from your smartphone or computer.
You dont need a referral from your PCP to seek help, but your PCP can help you best by being involved in your total care management.
Managing Your Total Health Together: The Process
You start to feel better.
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How Do I Get Help
Use Headway to find the best in-network mental health provider for your needs and preferences, across specialty, location, virtual or in-person care, personality, and race, language, and ethnicity. You can choose a date and time and book your first appointment in as soon as 48 hours.
Need help finding an outpatient behavioral health care provider? Use Quartet. Quartet can quickly match you to care based on your Blue Cross NC plan, needs and preferences.2
Use Shatterproof’s ATLAS to find an addiction and substance use disorder treatment facility for you or a loved one.3
Talk to your primary care provider. He or she can address your concerns in the office or refer you to a behavioral health provider.
Access our Blue ConnectSM member site to find an in-network provider. Search for keywords like: Psychologist, Psychiatrist, Social Worker, Therapist, Substance Use or Counselor.
Use your Employee Assistance Program , if available.3
Access therapy or psychiatry through your Telehealth benefit, if available.4
