CareFirst
Navigating mental health insurance shouldn't add to your stress. Learn how CareFirst BlueCross BlueShield covers behavioral health services and find the treatment you need.
When facing mental health challenges or substance use disorders, knowing your insurance coverage is essential to accessing timely care. CareFirst BlueCross BlueShield recognizes the importance of mental wellness and offers comprehensive coverage options for behavioral health services.
CareFirst provides coverage for a wide range of mental health and substance use disorder treatments as part of their commitment to complete healthcare. Your specific benefits will depend on your plan type, but all CareFirst plans include some level of mental health coverage in compliance with federal parity laws, which require that coverage for mental health services cannot be more restrictive than medical and surgical benefits.
Types of CareFirst Plans and Mental Health Coverage
CareFirst offers several plan types, each with different approaches to mental health coverage. HMO Plans require members to use providers within the behavioral health network for covered in-network benefits, typically not covering out-of-network care except in emergencies. POS Plans provide in-network coverage when you see providers in the behavioral health network, but also offer some out-of-network coverage, usually at higher cost-sharing levels. PPO Plans offer the most flexibility, allowing you to see both in-network and out-of-network providers, though costs are lower when staying in-network.
Understanding your specific plan is crucial as it determines which providers you can see and how much you'll pay out-of-pocket. Most CareFirst plans provide greater benefits when working with in-network providers compared to out-of-network options.
Mental Health Services Covered by CareFirst
CareFirst generally covers a comprehensive range of behavioral health services for both mental health conditions and substance use disorders. While specific coverage details vary by plan, commonly covered services include:
Outpatient Services
CareFirst typically covers individual therapy sessions with licensed providers, psychiatric evaluations and medication management, group therapy sessions, intensive outpatient programs (IOPs), and psychological testing. These services form the foundation of most mental health treatment plans and are often the first line of care.
Inpatient Services
For more intensive needs, CareFirst generally covers acute inpatient hospitalization for mental health crises, residential treatment programs, partial hospitalization programs (PHPs), and detoxification and rehabilitation services for substance use disorders. These higher levels of care provide structured treatment in controlled environments.
Additional Support Services
CareFirst also offers coverage for telehealth mental health appointments, addiction recovery programs, crisis intervention services, and case management and care coordination. These supplementary services help ensure comprehensive care and ongoing support throughout the recovery process.
CareFirst offers specialized support through their behavioral health care coordinators who can help connect you with appropriate providers and assist with navigating treatment options. These trained professionals are available 24/7 through CareFirst's dedicated mental health support line at 800-245-7013.
Verifying Your CareFirst Mental Health Benefits
Before seeking treatment, it's important to understand your specific coverage details to avoid unexpected costs. Start by reviewing your Summary of Benefits document, which outlines your mental health coverage, including copayments, coinsurance, and any coverage limitations—find this through your online CareFirst account or by contacting your HR department if you have employer-provided insurance. Next, check network status by verifying if your preferred provider is in-network using CareFirst's online provider directory or calling the provider directly with your insurance information.
Understanding your financial responsibility is crucial, as mental health services typically require cost-sharing in the form of copayments (fixed amounts paid at the time of service), coinsurance (percentage of costs you pay after meeting your deductible), and deductibles (amount you pay before CareFirst begins covering services). For personalized benefit information, contact Member Services by calling the number on the back of your CareFirst ID card.
Authorization Requirements for Mental Health Treatment
Many mental health services under CareFirst plans require prior authorization, particularly for higher levels of care. Understanding these requirements can help avoid coverage denials and unnecessary out-of-pocket expenses.
Services That Typically Require Prior Authorization
Many higher levels of mental health care require advance approval from CareFirst. These typically include inpatient hospitalization (except in emergencies), residential treatment programs, partial hospitalization programs (PHPs), and intensive outpatient programs (IOPs). Additionally, certain specialized testing or treatments and extended therapy beyond plan-allowed sessions may also need prior authorization before services begin.
For emergency mental health admissions, providers must notify CareFirst Case Management within 48 hours. For non-emergency services requiring authorization, the request should be submitted at least five days before service delivery.
Authorization Process
The authorization process differs depending on whether you're seeing in-network or out-of-network providers:
In-network providers: Typically handle the authorization process for you
Out-of-network providers: You may need to secure authorization yourself by contacting CareFirst's Prior Authorization department at 866-773-2884
Failure to obtain required authorizations can result in denied claims, so it's essential to verify requirements before beginning treatment. For ongoing care, CareFirst may conduct concurrent reviews to determine if extended treatment is medically necessary.
Navigating the Insurance Approval Process
Understanding how to navigate CareFirst's approval process can help ensure a smoother treatment journey:
Steps in the Approval Process
Initial assessment: A qualified provider evaluates your condition and recommends appropriate treatment.
Provider submission: For services requiring authorization, your provider submits clinical information to CareFirst justifying the medical necessity of requested services.
Review and determination: CareFirst reviews the information and makes a coverage decision based on medical necessity criteria.
Ongoing review: For continuing services like inpatient care, CareFirst conducts concurrent reviews to assess continued need for the level of care.
Tips for Successful Approvals
Work with providers experienced with CareFirst authorization processes
Ensure all required documentation clearly demonstrates medical necessity
Follow up on pending authorizations to prevent delays in care
Keep records of all communication regarding authorizations
If you receive a denial, you have the right to appeal. Your provider can help submit additional information to support your case, or you can file an appeal directly with CareFirst.
Finding CareFirst In-Network Mental Health Providers
Staying in-network typically results in lower out-of-pocket costs and smoother insurance processing. CareFirst offers several ways to find in-network mental health providers:
Online provider directory: Use CareFirst's "Find a Doctor" tool on their website, filtering specifically for behavioral health providers
Behavioral health support line: Call 800-245-7013 to be connected with CareFirst's team of specialty-trained clinicians who can help locate appropriate providers
Member services: Contact the number on your CareFirst ID card for personalized assistance
When searching for providers, consider factors beyond network status, such as:
Experience with your specific condition
Availability of appointment times
Treatment approaches and specialties
Location and accessibility
Telehealth options if needed
Managing Out-of-Pocket Costs for Mental Health Care
Even with insurance coverage, you may have financial responsibility for some mental health treatment costs. Understanding and planning for these expenses can help make treatment more accessible:
Typical Out-of-Pocket Expenses
When using your CareFirst coverage for mental health services, you may encounter several types of out-of-pocket expenses. Deductibles are the amount you must pay before CareFirst begins covering services, while copayments are fixed amounts (like $25 per session) paid at the time of service. Coinsurance represents a percentage of costs (like 20%) you're responsible for after meeting your deductible, and out-of-network charges are the higher costs incurred when seeing providers outside your plan's network.
Cost Management Strategies
Stay in-network: Choose providers who participate in CareFirst's network to minimize costs
Use telehealth options: Virtual visits may have lower copays than in-person appointments
Ask about sliding scale fees: Some providers adjust fees based on income
Check for preventive services: Some preventive mental health screenings may be covered without cost-sharing
Review your out-of-pocket maximum: This caps your annual spending on covered services
Unique Features of CareFirst Mental Health Coverage
CareFirst's Integrated Behavioral Health Program
One distinguishing aspect of CareFirst's approach to mental health is their integrated behavioral health program. This program connects members with specialty-trained behavioral health care coordinators who provide one-on-one support for conditions like depression, anxiety, and eating disorders. These coordinators help find appropriate providers, schedule appointments, and provide ongoing support throughout the treatment journey.
Substance Use Disorder Treatment Approach
For members struggling with substance use disorders, CareFirst offers specialized addiction programs that connect patients with trusted providers in outpatient settings. These programs include therapy, medication-assisted treatment options, support groups, and education as part of intensive outpatient treatment. This comprehensive approach acknowledges the unique challenges of addiction recovery and provides targeted support.
How to Determine if Your Specific CareFirst Plan Covers Needed Treatment
Mental health coverage can vary significantly between different CareFirst plans. To determine if your specific plan covers your needed treatment:
Locate your Summary of Benefits document: This outlines your specific coverage details, including mental health and substance use disorder benefits. Find the section labeled "Mental Health and Substance Disorder" to see what services are covered and at what cost-sharing levels.
Check for service-specific information: Look for details about different levels of care (outpatient, inpatient, etc.) and any limitations on number of visits or days of coverage.
Verify in-network vs. out-of-network coverage: Understand how coverage differs depending on provider network status.
Contact Member Services: For questions about specific treatments or providers, call the number on your CareFirst ID card.
Speak with your provider: Mental health professionals familiar with CareFirst can often help interpret coverage for specific treatments.
Remember that coverage determination ultimately happens when claims are processed, based on your eligibility, plan terms, and the specific services provided.
Benefits of Choosing a Facility That Accepts CareFirst
Selecting a treatment facility that accepts CareFirst insurance offers several advantages:
Lower out-of-pocket costs: In-network facilities have agreed-upon rates with CareFirst, resulting in lower patient costs.
Streamlined billing process: In-network facilities handle most insurance paperwork and billing directly with CareFirst.
Coordination of care: CareFirst's behavioral health care coordinators can work with in-network facilities to ensure appropriate care and smooth transitions between levels of treatment.
Simplified authorization process: In-network facilities are familiar with CareFirst's requirements and handle most authorization procedures for you.
Quality assurance: Facilities in CareFirst's network must meet certain standards for quality and appropriate care.
Find Treatment Centers That Accept CareFirst Today
Ready to take the next step? Browse our directory of treatment facilities that accept CareFirst insurance to find the right match for your needs. Our comprehensive listings include information about services offered, treatment approaches, and location details to help you make an informed decision.
Don't let insurance concerns delay your path to wellness. With the right coverage information and support, you can access the care you need to begin your recovery journey.