The short version
If you have BCBS of Massachusetts:
- Mental health benefits are generally covered the same way as physical health benefits (this is mental health parity, required by federal and state law).
- You can usually see an in-network therapist with a copay (often $25 to $40, depending on plan).
- You can see an out-of-network therapist with partial reimbursement (often 50 to 70% of the allowed amount after meeting your out-of-network deductible).
- Most plans do not require prior authorization for outpatient therapy.
- Telehealth is covered the same as in-person.
The specifics depend on your plan. The rest of this post helps you figure out yours.
Step 1: Find out exactly what plan you have
BCBS of Massachusetts has many products: HMO, PPO, EPO, POS, and several state programs (GIC for state employees, etc.). The product name affects what you can do.
Find your plan name on your insurance card or in the BCBS member portal. Common ones in MA include:
- HMO Blue / HMO Blue New England: generally requires staying in network
- Blue Care Elect / PPO: allows out-of-network with higher cost share
- EPO: in-network only (similar to HMO)
- GIC plans (Group Insurance Commission, for MA state employees): vary by underlying plan
- HMO Blue Select / Hospital Choice Cost-Sharing: has tiered hospitals; less relevant for outpatient therapy
- Indigo: often a higher-deductible plan
Aurora Counseling Associates is in-network with most BCBS MA plans. Call us with your specific plan name and we will check.
Step 2: Verify your specific therapy benefits
Two ways to do this:
Option A: Ask us to verify
Most therapy practices, including ours, will run a benefits check for you before your first session. Call us with your insurance card information and we will tell you what we find: your copay, your deductible status, whether you have any session limit, and any flags we see.
Option B: Call BCBS directly
Call the member services number on the back of your card. Ask:
- "What is my copay for outpatient mental health sessions with an in-network provider?"
- "Do I have a deductible for outpatient mental health? If yes, what is it and how much have I met?"
- "Is prior authorization required for outpatient therapy?"
- "Is there a session limit?"
- "What is my out-of-network mental health benefit if I see a provider who is not in network?"
- "Is telehealth covered the same as in-person?"
Write down the answers and the reference number for the call. BCBS reps are required to give you a reference number for benefit calls; that protects you if there is a billing dispute later.
Step 3: Understand copays, deductibles, and coinsurance
These three terms get conflated and they are different things.
- Copay: a flat fee you pay per session ($25, $40, etc.). With many BCBS plans, mental health sessions have a per-session copay.
- Deductible: the amount you have to pay out of pocket before insurance starts paying. Some plans have no mental health deductible; some have a combined medical and mental health deductible. If you have not met your deductible, you may pay the full session rate until you do, then drop to your copay.
- Coinsurance: a percentage you pay after the deductible is met. Common for out-of-network benefits (e.g., insurance pays 70%, you pay 30%).
If your benefits look high before the deductible is met and low after, that often surprises clients early in the year. It is worth knowing in advance.
Step 4: In-network vs. out-of-network
If your therapist is in-network with BCBS:
- You pay your copay (or your full rate until deductible is met, then your copay)
- The therapist bills BCBS directly
- No additional paperwork on your end
- You can only see in-network providers if you have an HMO/EPO; you have more flexibility with a PPO
If your therapist is out-of-network:
- You typically pay the full session rate up front
- The therapist gives you a "superbill" (a receipt with diagnostic and procedure codes)
- You submit the superbill to BCBS for partial reimbursement
- Reimbursement is usually 50 to 70% of the "allowed amount" (which is often less than what you paid), after your out-of-network deductible is met
- The out-of-network reimbursement process takes weeks
- HMO plans typically do not have out-of-network coverage; PPO plans do
Aurora is in-network with most BCBS MA plans, which makes the process simpler. If you are using out-of-network benefits with us, we provide superbills.
Step 5: Prior authorization
For outpatient psychotherapy, BCBS of MA does not typically require prior authorization. You can start therapy without getting permission from your insurance.
For higher levels of care (intensive outpatient programs, partial hospitalization, inpatient), prior authorization is often required and the provider handles it.
Common scenarios
"My BCBS plan says I have a $2,000 deductible. What does that mean for therapy?"
You will pay the full session rate (often $200 to $250) for each session until you have spent $2,000 out of pocket on covered healthcare for the year. Once you hit the deductible, your insurance begins paying its share and your cost drops, often to a copay of $25 to $40 per session.
If you are starting therapy in January and have a high deductible, the first several sessions will be at full freight. Many clients use HSAs to soften this.
"My copay is $40 but the practice says they are charging me more. Why?"
This usually means the deductible has not been met yet. Once you meet your deductible, the copay applies and the larger charge goes away.
"I want to see an out-of-network therapist. How much will I get back?"
It depends on your plan. A common scenario: a PPO plan reimburses 60% of the "allowed amount" for out-of-network outpatient mental health, after a $500 out-of-network deductible. If the "allowed amount" is $150 and you paid $250 for the session:
- You meet the $500 deductible after a few sessions
- After that, BCBS reimburses 60% of $150 = $90 per session
- Your effective out-of-pocket is $250 - $90 = $160 per session
The exact numbers vary by plan. Call BCBS and ask the specific questions in Step 2.
"I have GIC. Is that different?"
The Group Insurance Commission contracts with multiple insurers, including BCBS, for Massachusetts state employees. Coverage varies by the underlying plan you chose. Aurora is in network with several GIC plans; call us with your specific plan and we will check.
"I have BCBS but I am not in MA. Can I still see you?"
BCBS plans across the country participate in a national network (BlueCard) that allows out-of-state BCBS members to use in-network benefits with in-network providers in other states. If you have BCBS from another state but are seeking telehealth therapy while located in MA, VT, MI, FL, or CT (where our clinicians are licensed), this can sometimes work. Call us to check.
Massachusetts mental health parity
Federal and state mental health parity laws require insurance plans to cover mental health and substance use disorders the same way they cover other medical care. In practice, this means BCBS cannot impose stricter limits, higher cost sharing, or harder prior-auth requirements on therapy than they impose on physical health visits.
If you ever feel like your insurance is making mental health care harder to access than physical care, the Massachusetts Division of Insurance handles parity complaints. The Office of Patient Protection (under the Department of Public Health) is also a resource.
What Aurora Counseling Associates accepts
We are in-network with:
- Blue Cross Blue Shield (most MA plans)
- Tufts Health Plan (HMO/PPO/GIC)
- Tufts Health Direct
- Harvard Pilgrim
- Point32Health
- Optum
- United Behavioral Health
- Mass General Brigham Health Plan
- Health Plans Inc.
Some clinicians also accept Aetna and United Healthcare. We provide superbills for out-of-network reimbursement and accept HSA, FSA, and credit cards.
Self-pay is $200 to $250 per session.
If you have BCBS and are considering starting therapy with us, reach out or call (508) 650-0991. We will run a benefits check for you before your first session so you know what to expect.