Using your Blue Cross Blue Shield of Texas plan for virtual outpatient treatment.
Blue Cross Blue Shield of Texas is the largest health insurer in the state, operated by Health Care Service Corporation (HCSC). Many Texas employers, from energy and construction to large self-funded groups, run their behavioral health coverage through BCBSTX. Your plan is unique. We verify yours specifically before you commit to anything.
The honest version.
We are out of network with commercial carriers. In-network credentialing is in progress. We verify your out-of-network benefits and tell you the real out-of-pocket number before you start.
What we will and will not tell you about cost.
We do not waive cost-shares. We do not tell you treatment is free. We verify your OON benefits, give you the real number, and if cost is a genuine barrier we will talk about it case by case.
HCSC, PPO, and the self-funded employer book.
Blue Cross Blue Shield of Texas is the Texas licensee operated by Health Care Service Corporation. Its commercial products include PPO plans, which usually carry an out-of-network benefit, and HMO products such as Blue Advantage HMO, which usually do not pay out of network except for emergencies. A large share of BCBSTX membership sits in self-funded employer plans where the employer's plan document, not the carrier brochure, controls the out-of-network behavioral benefit. The structure that matters for treatment is whether your specific plan carries an out-of-network behavioral health benefit at all, and what its terms are. We pull that for you before anything starts.
The pieces of the plan
- An allowed amount for each kind of visit or day of behavioral care.
- A deductible you meet before the plan starts splitting the cost.
- A coinsurance split after the deductible.
- An out-of-pocket maximum for the year, after which the plan covers more or all.
- An authorization step for intensive outpatient and PHP-intensity hour expansion, which we handle.
What we do for you on the benefits side
- Call BCBS Texas on the back of your card and pull the actual out-of-network behavioral numbers for the level of care you need.
- Translate them into the dollar cost of a week of treatment, so there are no surprises.
- Submit the authorization and stay on the case through review and renewal.
- Bill what the plan considers reasonable, so there is no balance-bill surprise later.
Which kind of BCBSTX plan you have changes the answer.
The front of your card and the plan name tell us a lot. A PPO product usually includes an out-of-network behavioral benefit. An HMO product usually does not pay out of network outside an emergency. A self-funded employer plan administered by BCBSTX follows the employer's plan document, which can be more or less generous than a fully insured commercial plan. We read the one you actually have.
The standard OON behavioral benefit
Most BCBS Texas PPO plans include an out-of-network behavioral health benefit with a separate OON deductible and a coinsurance split after that. We pull yours before you commit.
Start the benefit check Self-funded employer planThe plan document is the source of truth
If your BCBSTX coverage is a self-funded employer plan, the employer's plan document controls the out-of-network behavioral benefit, not the carrier brochure. Send us the front of your card and any plan materials and we will read them together.
Start the benefit checkYou attend from where you are physically located.
Telehealth licensure follows the state where the patient is physically located during the session. Our clinical team is licensed in California, and we treat patients who are physically in California during their sessions. If your situation involves another state, we will tell you honestly on the first call whether we are the right fit or whether we should help you find a licensed provider in your location.
Plain-English answers.
Are you in network with BCBS Texas?
No, we are out of network with Blue Cross Blue Shield of Texas and with commercial carriers generally. In-network credentialing is in progress. Many BCBSTX PPO plans include an out-of-network behavioral health benefit, and we bill out-of-network.
What is HCSC and why is it on my paperwork?
Health Care Service Corporation is the company that operates Blue Cross Blue Shield of Texas, along with the Blue plans in Illinois, Oklahoma, New Mexico, and Montana. It is the largest customer-owned health insurer in the country. For your benefit check, the operating company does not change anything: we call the member services line on your card and pull your actual out-of-network behavioral benefit.
Does it matter if my plan is an HMO or a PPO?
Yes. BCBSTX PPO products usually include an out-of-network behavioral benefit. HMO products such as Blue Advantage HMO usually do not pay out of network except in an emergency. We confirm which kind you have before you commit.
How do I find out what my plan really covers?
Send us the member ID and group number on the front of your card. We call the plan, pull the actual out-of-network behavioral numbers for the level of care you need, and translate them into what a typical week of treatment would cost you, before you start.
Will my employer find out?
No. Substance use treatment records are protected under 42 CFR Part 2. We do not release any information to your employer without your written consent. The exception is if the law requires it or if your safety is at risk.
How fast can I start?
Typically same or next business day for the clinical assessment, and within the same business week for program start, once benefits and authorization are confirmed.
Verify your benefits in two minutes.
Send us the member ID and group number on the front of your card. We come back with your specific out-of-network deductible, coinsurance, out-of-pocket maximum, and what a typical week of intensive outpatient or partial hospitalization-intensity care would cost you. No commitment until you decide.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide & Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service. Substance use treatment records are protected by 42 CFR Part 2.