2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Professional Services
Section 5(e). Mental Health and Substance Use Disorder Benefits
Professional Services
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Professional Services
We cover professional services by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license.
You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
Benefit Description
Professional Services
We cover professional services by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license.
You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
Benefit Description
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license
Outpatient professional services including:
Notes:
10/3/22 correction (red text):
We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required.
You Pay
Preferred: $10 copayment (no deductible) per visit up to a combined total of 10 visits per calendar year (benefits combined with visits in Section 5(a), page 39)
Preferred provider, visits after the 10th visit: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license
Outpatient professional services including:
- Individual psychotherapy
- Group psychotherapy
- Pharmacologic (medication) management
- Office visits
- Clinic visits
- Home visits
- Phone consultations and online medical evaluation and management services (telemedicine)
Notes:
10/3/22 correction (red text):
- We cover up to
48 visits per year in full to treat depression associated with pregnancy under maternity benefits (i.e., depression during pregnancy, postpartum depression, or both) when you use a Preferred provider. See page 45.
- To locate a Preferred provider, visit www.fepblue.org/provider to use our National Doctor & Hospital Finder, or contact your Local Plan at the mental health and substance use disorder phone number on the back of your ID card.
- See pages 55 and 98 for our coverage of smoking and tobacco cessation treatment.
We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required.
You Pay
Preferred: $10 copayment (no deductible) per visit up to a combined total of 10 visits per calendar year (benefits combined with visits in Section 5(a), page 39)
Preferred provider, visits after the 10th visit: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Telehealth professional services for:
Notes:
You Pay
Preferred Telehealth Provider: Nothing (no deductible) for the first 2 visits per calendar year for any covered telehealth service received (benefits are combined with telehealth services listed in Section 5(a), page 39)
$10 copayment per visit (no deductible) after the 2nd visit
Non-preferred (Participating/Non-participating): You pay all charges
Telehealth professional services for:
- Behavioral health counseling
- Substance use disorder counseling
Notes:
- Refer to Section 5(h), Wellness and Other Special Features, for information on telehealth services and how to access our telehealth provider network.
- Copayments are waived for members with Medicare Part B primary.
You Pay
Preferred Telehealth Provider: Nothing (no deductible) for the first 2 visits per calendar year for any covered telehealth service received (benefits are combined with telehealth services listed in Section 5(a), page 39)
$10 copayment per visit (no deductible) after the 2nd visit
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license:
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license:
- Inpatient professional services
- Professional charges for facility-based intensive outpatient treatment
- Professional charges for outpatient diagnostic tests to include psychological testing
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges