Loading Profile...
Why does my PPO policy cover individual and family therapy, but not relationship or marriage counseling any more. From December 2010 - March 2011 My wife and I attended marriage counseling and it was covered under our plan. We recently started going again, seeing the same counselor who was previously covered and I was informed by a representative that we no longer have any coverage for this treatment.
Being that there is a direct benefit to the health of the economy through marriage as well as direct benefit to the individual as a result of a stable and healthy mental attitude, it seems a bit short sighted to have dropped this coverage.
Denying these benefits, which were just earlier this year, provided as part of my PPO plan seems like an unwise decision when viewed in the light of preventing depression and other forms of stress as well as the physical effects of increased mental strain due.
I am aware that the benefit year changed in July, I was just curious why this change was made to policies for state employees. I receive less coverage under my new policy, but I still pay the same premiums and deductibles.
Help get this topic noticed by sharing it on
Twitter,
Facebook, or email.
Twitter,
Facebook, or email.
No marriage counseling coverage anymore?
-
EMPLOYEE
I’m
confident
Mr Carter,
We apologize for any inconvenience this may have caused you and hope we can shed some light on the situation. We certainly understand the correlation between economy and its impact on mental health.
There have been no changes to the mental health benefits for state employees. Marriage and/or relationship counseling is not, and has not been, covered under state employee policies. However, individual and family therapy is and has been covered.
It is possible that your counselor is submitting your claim as marriage/relationship counseling now and had submitted it as family or individual counseling in the past. This would explain the difference in your coverage. You can talk to your provider about what service codes he or she is submitting your services under and ask him or her to resubmit the claims under family therapy code.
If you would like more information, please contact our Care Management Department directly at 1-800-743-1871 to discuss your covered services.Comment -
-
In reviewing my previous policy I see that you are correct that Blue Cross has not covered marriage counseling in the past. Why is that? In light of the fact that people in a happy marriage tend to be healthier and more productive what sense does it make to not cover this type of counseling?
-
-
EMPLOYEE
I’m
confident
As a health insurance company, we have to provide coverage for services our members, and membership groups want, while maintaining a cost level they can afford. Many companies provide marriage counseling through their employee assistance programs (EAP), meaning our coverage for this would potentially increase costs while supplying coverage already provided to the member through other avenues.
We encourage you to talk with your human resources department about your EAP benefits. You can also ask your provider if the services he or she provided would fall under family counseling. If it does, he or she can resubmit the claim under the corrected service code.
If you have further questions about your benefits, you can also contact our Customer Service Department at the phone number on the back of your Blue Cross of Idaho ID card.
Sincerely,
Blue Cross of Idaho -
