Does Anthem cover therapy?

Mental health is an essential part of your overall well-being, and therapy plays an important role in maintaining it. If you’re considering therapy, you may wonder, Does Anthem cover therapy? In this guide, we’ll explore Anthem Blue Cross and Blue Shield’s mental health benefits, coverage details, costs, and practical steps for accessing therapy. Whether you’re looking for in-person or virtual therapy sessions, we’ve got you covered.

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Does Anthem cover therapy?

Yes! Anthem Blue Cross and Blue Shield plans do cover therapy as part of essential mental health benefits under the Affordable Care Act (ACA). If you have an individual, family, employer-sponsored, or ACA-compliant plan, therapy services, including both in-person and virtual visits, are included.

What types of therapy does Anthem Blue Cross and Blue Shield cover?

Anthem generally includes coverage for the following types of therapy:

• Outpatient psychotherapy and counseling: Provided by licensed professionals such as psychologists, licensed clinical social workers (LCSWs), and licensed marriage and family therapists (LMFTs).
• Virtual therapy sessions: Available through Anthem’s Sydney Health app or authorized telehealth platforms.
• Inpatient or residential mental health care: Covered when deemed medically necessary.
• Psychiatric medication management: Including evaluations and follow-ups with psychiatrists.
• Substance use disorder treatment: Covering both outpatient services and residential programs.
• Employee Assistance Programs (EAPs): These are employer-sponsored programs that may offer a limited number of free counseling sessions. The number of sessions and services provided can vary depending on the employer.

What types of therapy are not covered by Anthem Blue Cross and Blue Shield?

The following types of therapy are generally not covered unless explicitly included in your plan:

• Experimental or non-FDA-approved therapies: For example, wellness coaching or alternative modalities that lack clinical backing.
• Out-of-network providers: These are not covered unless in emergency situations or with prior approval.
• Non-clinical alternative therapies: Services like Reiki, energy healing, or life coaching are typically not included, unless explicitly stated in your plan’s benefits.
• Personal services not related to medical care: Relaxation or spa massages.

Does Anthem Blue Cross and Blue Shield cover online therapy?

Yes, most Anthem plans include coverage for online therapy, often with lower copays. Anthem provides several ways to access virtual therapy:

• Sydney Health app: Anthem’s free app on which you can connect with licensed therapists via the app.
• Third-party behavioral health platforms: These platforms partner with Anthem to provide therapy services.

Online therapy allows you to receive private, convenient, and timely care from the comfort of your own home.

How to check if your Anthem Blue Cross and Blue Shield plan covers therapy

To confirm whether your specific plan covers therapy, follow these steps:

1. Review your Summary of Benefits and Coverage (SBC): Look for sections labeled “Behavioral Health,” “Outpatient Therapy,” or “Mental Health.”
2. Log in to your Anthem account or Sydney Health app: Use the “Find Care” tool to search for in-network mental health providers.
3. Call Member Services: Use the number on your insurance card to inquire about copays, deductibles, coverage details, or prior authorization requirements.
4. Review your plan’s drug formulary: Ensure psychiatric medications are covered under your pharmacy benefits.
5. Know your plan type: The type of plan you have, such as an HMO, PPO, or EPO, determines which providers are considered in-network.

How much does Anthem cover for therapy?

Understanding how much you’ll actually pay for therapy with Anthem can be confusing, especially when copays, deductibles, and provider networks vary by plan. While  Anthem provides mental health benefits across most plans, the amount covered depends on several factors. Including: 

• Your plan type (HMO, PPO, or EPO) and whether the provider is in-network.
• Whether you’ve met your annual deductible.
• Your copay or coinsurance responsibilities.
• Whether the therapist is credentialed with Anthem.

Even within the same type of plan, coverage details can vary, so it’s important to check your plan documents or call Anthem Member Services for exact figures.

In-network vs. out-of-network providers: A cost comparison

Choosing between in-network and out-of-network providers significantly affects your costs. Here’s how the costs typically compare:

It is always advisable to choose in-network providers to reduce out-of-pocket expenses unless your plan includes partial reimbursement for out-of-network services.

Why Anthem might deny therapy coverage

Anthem may deny therapy coverage for several reasons:

• No prior authorization was submitted (when required).
• Use of an out-of-network provider without exception approval.
• Lack of medical necessity or incomplete documentation.
• Missing referral from a primary care provider (PCP), required by some HMO plans.

Tips for improving your chances of therapy approval

To increase your chances of therapy approval:

• Choose in-network therapists whenever possible.
• Get a referral from your PCP if required by your plan.
• Ask your therapist to submit prior authorization with detailed clinical notes.
• Ensure your provider documents a diagnosis and treatment goals.
• Use Anthem’s tools like Sydney Health or Member Services to stay informed.
• Appeal coverage denials by submitting additional medical evidence.

How to get prior authorization from Anthem for therapy

To obtain prior authorization for therapy:

1. Speak with your therapist or psychiatrist to determine if it’s necessary.
2. Complete the appropriate authorization form, typically handled by your provider.
3. Include supporting documents, such as diagnoses, treatment plans, and progress notes.
4. Track approval status through Anthem’s member portal or contact member services.
5. If denied, you can file an appeal with additional supporting evidence.

Will Anthem cover your mental health care? 

Therapy is covered under most Anthem plans, but it’s important to check your plan for copays, deductibles, and referral requirements so you won’t be surprised by any costs. Using in-network or virtual providers can also help reduce costs and avoid any billing surprises.

Next steps to get therapy covered by Anthem online

Ready to start therapy? Book your appointment through Klarity Health to find licensed, in-network providers. Verify your benefits instantly and avoid billing surprises. Begin with a virtual session during which your therapist will assess your needs and handle any required authorization. Klarity Health streamlines the process, providing support for insurance-related questions and appeals.

Not sure if your insurance covers therapy?

Licensed providers on Klarity Health can assess your condition and guide you toward care that fits your needs—coverage varies by plan.

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