2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 88
 
Benefit Description

Professional Services (cont.)

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

Notes:
  • We cover up to 4 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 48.
     
  • 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 telephone number on the back of your ID card.
     
  • See pages 58 and 100 for our coverage of smoking, tobacco, and E-cigarette 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

Non-preferred (Participating/Non-participating): You pay all charges
 
Benefit Description

Telehealth professional services for:

 
  • Behavioral health counseling
     
  • Substance use disorder counseling

Note: Refer to Section 5(h), Wellness and Other Special Features, for information on telehealth services and how to access our telehealth provider network.

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:

 
  • 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

Non-preferred (Participating/Non-participating): You pay all charges
 
Inpatient Hospital or Other Covered Facility - continued on next page