Reflections Mental Health Services

By Alphonso Gaita, LCSW. Reflections Mental Health Services. Telehealth across New York State

Blue Cross Blue Shield is one of the biggest insurers in New York, but “BCBS” is really a family of different products: Anthem BCBS, Empire BCBS, Excellus, BlueShield of Northeastern New York, BlueCross BlueShield of Western New York, and more. They share a logo and a general network philosophy, but each plan sets its own coverage rules.

If you’ve got a BCBS card and you’re looking for Blue Cross Blue Shield therapy in New York, here’s how to actually use those benefits without the runaround.

What BCBS usually covers for mental health

• Outpatient psychotherapy: individual therapy sessions
• Telehealth therapy: covered at the same rate as in-person on most current plans
• Initial intake / diagnostic evaluation: billed under a different code than ongoing sessions
• Psychiatric medication management: separate from therapy
• Some couples therapy: handled case by case, depending on diagnosis
• Group therapy: usually covered when it’s clinically indicated

Find your specific BCBS plan name

The single most useful thing to know when you’re using BCBS benefits is your specific plan name, not just “Blue Cross Blue Shield.” The common ones in NY:

• Anthem Blue Cross Blue Shield
• Empire BlueCross BlueShield
• Excellus BlueCross BlueShield
• BlueShield of Northeastern New York
• HealthNow / BCBS of Western New York
• BlueCross BlueShield Federal Employee Program (FEP)

When you call a therapist’s office, give them the exact name. “I have BCBS” won’t cut it, because they need the specific product to check in-network status.

3 questions to ask BCBS before booking

1. What’s my copay or coinsurance for outpatient mental-health visits?
2. What’s my deductible, and how much of it have I met this year?
3. Are telehealth mental-health sessions covered the same as in-person?

Ask them to email you a written verification of benefits (VOB). The phone rep has to send you one if you ask.

What an in-network BCBS therapy session costs in NY

• Copay-based plan: $20 to $60 per session after your deductible
• Coinsurance-based plan: 20 to 30% of the contracted rate, usually $30 to $80 per session
• High-deductible plan (HDHP): the full session rate ($100 to $200) until you hit your deductible, then copay or coinsurance kicks in

You can use HSA and FSA funds for therapy copays and deductibles.

In-network vs out-of-network with BCBS

• In-network: Pay your copay or coinsurance at the session. Done.
• Out-of-network: Pay the full rate up front, submit a superbill, then wait weeks for partial reimbursement (often 50 to 60% after a separate deductible).

Reflections is in-network with Blue Cross Blue Shield (including Anthem BCBS and Anthem Blue Cross). Full insurance details here.

Finding an in-network BCBS therapist in NY

1. Use BCBS’s online directory. Log into your member portal and search “behavioral health” or “mental health” providers in your zip.
2. Know that the directory is incomplete. Plenty of in-network therapists aren’t listed, and plenty of listed therapists aren’t taking new clients. Cross-check before you count on it.
3. Filter for telehealth. Most BCBS plans now treat telehealth like in-person.
4. Verify acceptance directly. When you reach out to someone, give them your full plan name and ask: “Are you in-network with [exact plan] and taking new clients?”

Or just contact us. We’ll verify your specific BCBS plan and confirm your benefits before your first session.

If a therapist you like doesn’t take your BCBS plan

• Ask if they’ll see you out-of-network and give you a superbill
• Ask if they offer a sliding-scale rate
• Check whether you have out-of-network benefits. Many BCBS plans do, especially PPOs
• Self-pay with us is $150 for a 60-minute individual session, and sliding-scale rates are available

Don’t let confusion be the reason you wait

Insurance is the most common reason people put off therapy in NY, and it’s one of the worst reasons to wait. If you have BCBS, your benefits are already there. Use them. We offer no waitlist therapy in New York, with same- and next-day appointments often available. Call our Billing Department at (718) 255-5120 for a benefits check.

References

• Blue Cross Blue Shield Association. (2024). Behavioral Health Coverage Standards.
• Centers for Medicare & Medicaid Services. (2024). Mental Health Parity and Addiction Equity Act.
• New York State Department of Financial Services. (2024). Mental Health Insurance Coverage in New York.
• Kaiser Family Foundation. (2024). Mental Health Coverage and Access in Commercial Insurance.