FAQ » Insurance Information » Florida Blue

Florida Blue

One of the first questions many people have when they’re considering substance abuse, mental health, or behavioral health treatment is whether or not their insurance company will entirely or partially cover the cost. Blue Cross Blue Shield (BCBS) is accepted in all 50 states and covers more than 100 million Americans. BCBS is made up of more than 35 independent and locally operated agencies, and more than 96 percent of hospitals and 92 percent of healthcare providers work directly with a BCBS agency. Blue Cross Blue Shield is accepted, at least on some level, by most addiction treatment centers, although coverage can vary widely from state to state.

The Mental Health Parity Act stops discrimination so that mental health treatment and substance abuse/addiction treatments are considered equal to treatment for medical health issues. In the past, insurers could place higher co-pay prices on mental health services and employers could limit the number of days their employees were hospitalized and/or attending outpatient services. These historical moves have made it much easier to obtain care. Lower prices and better cooperation within the workplace can help clients get the help they need sooner.

Oftentimes only a portion of detox, addiction treatment, or mental health treatment will be covered by your insurance. It’s important to speak with your insurance company to determine your exact level of coverage and to understand what that translates to in terms of the amount you will pay out of pocket.

Let’s get started with some common terms and definitions:

Copayment: a fixed dollar amount you are required to pay for covered services at the time you receive care.

Deductible: a fixed amount of the eligible expenses you are required to pay before reimbursement by your health plan begins.

In-network: services provided by a physician or other health care provider with a contractual agreement with the insurance company and paid at a higher benefit level.

Out-of-network: services provided by doctors and hospitals who have not contracted with your health plan.

Out-of-pocket maximum: also called OOPM, this is the most you have to pay out of your own pocket for expenses under your insurance plan during the year. Deductibles, coinsurance, copays and other expenses for in-network essential health benefits (EHBs) apply to the OOPM.

Preauthorization: the process by which members or their primary care physicians (PCP) notify the health plan in advance of treatment plans, such as a hospital admission or a complex diagnostic test. Also called pre-notification.

Premium: the ongoing amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. The premium may not be the only amount you pay for insurance coverage. Typically, you will also have a copayment or deductible amount in addition to your premium.

Blue Cross Blue Shield offers 9 plans to residents of Florida, all of which cover substance abuse services. These plans can be divided into three basic types: BlueOptions Essential, BlueOptions EveryDay Health, and BlueOptions All Copay.

Florida BlueOptions Essential

After you have met the deductible under the BlueOptions Essential plans, you won’t pay any copays or coinsurance for services. Premiums for this plan will vary based on income and other factors.

Florida BlueOptions Everyday Health

The BlueOptions Everyday Health plans require copays and/or coinsurance after you have met your plan’s deductible.

Florida BlueOptions All Copay

Under the All Copay plans there are no deductibles, however, all covered services require a copay.

Is Mental Health Care Covered by Florida Blue?

Diagnostic evaluation, psychiatric treatment, individual therapy, and group therapy administered by a Physician, Psychologist, or Mental Health Professional for the treatment of a Mental and Nervous Disorder may be covered. Covered Services may include office visits, Intensive Outpatient Treatment (rendered in a facility), partial hospitalization when provided under the direction of a Physician, and Residential Treatment Services. Some mental health services may be excluded in your plan, so be sure to check with your provider.

Is Substance Abuse Treatment Covered by Florida Blue?

Care and treatment coverage for substance abuse includes the following: Inpatient and Outpatient services administered by a Physician, Psychologist, or Mental Health Professional in a program accredited by The Joint Commission or approved by the state of Florida for Detoxification or Substance Dependency.

Is Residential Treatment Covered by Florida Blue?

Residential Treatment is generally covered, and benefits include room and board, general nursing service, therapy services, and other ancillary services. Preauthorization is required. If preauthorization is not obtained, benefits will be denied.