Let’s face it, the cost of mental health support can be quite costly without the right insurance plan. Even a few therapy sessions can stretch the budget for many Americans.
The good news is that comprehensive health insurance can save you thousands each year. Buckeye Health Plan helps members access essential mental health services with full coverage options.
Follow along as we break down all you need to know about Buckeye Health Plan, including the details about its mental health and therapy coverage options. Discover what healthcare services are included and how to effectively utilize your benefits for mental health care so you can start your journey to better mental well-being.
Key takeaways
- Buckeye Health Plan offers mental health and therapy coverage including in-person and online options for anxiety, depression, trauma, and substance use disorders.
- Common therapies covered include CBT, DBT, EMDR, family therapy, group therapy, and more.
- Average session costs vary by state but are often around $40 after meeting the deductible. Most Buckeye Health Plan services do not require copays.
- Members can self-refer for therapy services without needing approval from a primary care provider or Buckeye.
- Denied claims can often be resolved by checking for errors, submitting appeals, or requesting external reviews.
What is Buckeye Health Plan insurance?
Buckeye Health Plan is a managed care organization providing Medicaid insurance coverage across the state of Ohio. Types of coverages offered include, but may not be limited to:
- Medical services (i.e. preventative care, emergency services outpatient, inpatient hospital services, maternity, pediatric care, laboratory services and prescription drugs)
- Behavioral health services (i.e. mental health treatment and substance use disorder treatment)
- Dental and vision coverage
- Transportation assistance
- Care coordination
- Disease coaching
- Home health care
- Hospice care
- Telehealth services
Buckeye Managed Medicaid benefits are part of the greater Health Plan, catering specifically to low-income individuals and families qualifying for Medicaid by providing essential health services at little to no cost. MyCare Ohio is another specialized program designed for Ohio residents who are eligible for both Medicare and Medicaid. MyCare Ohio offers provider services for seniors and individuals with disabilities.
As part of its Medicaid managed care services, Buckeye Health Plan offers comprehensive mental health care coverage for conditions like anxiety, depression, and trauma. Members on managed care plans can access various therapeutic options, including cognitive behavioral therapy (CBT), family therapy, and group therapy, as well as specialized programs like BuckeyeSpectrum for schizophrenia and counseling for substance use disorders.
Does Buckeye Health Plan cover therapy?
Yes, Buckeye Health Plan covers both in-person and online therapy, along with mental health services for substance abuse, anxiety disorders, relationship issues, depression, OCD, and more.
What therapy does Buckeye Health Plan cover?
Buckeye Health Plan insurance covers many types of therapy that serve as quality care options for many types of conditions.
Members should always confirm what types of therapy your specific Buckeye Health Plan covers, but in general, the types of psychotherapy typically included are:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Mindfulness-Based Therapy
- Psychodynamic Therapy
- Eye movement desensitization and reprocessing therapy (EMDR)
- Substance use disorder group and individual counseling
- Family therapy
- Group therapy
Other types of therapy that Buckeye Health Plan may cover, depending on diagnosis, previous therapies, and your insurance plan details:
- Community psychiatric supportive treatment (CPST)
- Psychosocial rehabilitation
- Multisystemic therapy
- BuckeyeSpectrum for Schizophrenia Spectrum Disorder
- Cognitive enhancement therapies
- Social skills development interventions
- Memory and attention improvement technique
- Esketamine (Spravato)
Buckeye Health Plan covers mental health services from the following types of providers:
- Licensed clinical social workers (LCSW)
- Marriage and family therapists (MFT)
- Psychiatrists
Learn more about the types of therapy available when seeking mental health care, and be sure to double-check your specific Buckeye Health Plan or reach out directly to understand what therapy may be covered by your insurance.
Medication coverage with Buckeye Health Plan
Buckeye Health Plan offers medication coverage including prescription medications and certain over-the-counter medications ordered by your physician or mental health clinician.
Other important medication coverage considerations include:
- Plans may require prior authorization on some medications regarding age, dosage, and maximum quantities
- Brand-name medications are not covered if a generic option is available without prior authorization
- Members may be eligible for mail-order medication for a 90-day supply
- For certain medications, members (or their physicians) must receive prior authorization before filling the prescriptions
For the most up-to-date information on medication coverage, members should consider consulting the Unified Preferred Drug List or contacting Buckeye Health Plan directly.
What types of therapy does Buckeye Health Plan not cover?
Buckeye Health Plan covers many types of therapy which may help an individual with their mental health needs. However, there are some types of mental health services which are not covered by Buckeye Health Plan.
These services include, but may not be limited to:
- Hypnotherapy: Hypnotherapy uses hypnosis to help people with their mental health problems. Although some people find it helpful, Buckeye Health Plan does not believe it is a reliable or effective treatment for mental health issues.
- Non-traditional therapy: Non-traditional therapy, such as biofeedback therapy, aims to help people control their body’s response to stress and anxiety by giving them feedback about their body’s functions, like their heart rate or blood pressure. Buckeye Health Plan does not cover this type of therapy because they do not think there is enough evidence to prove that it’s an effective form of treatment.
- Holistic therapy: Similar to other non-traditional therapies, holistic approaches focus on integrating mind, body, and spirit, using practices like yoga, meditation, or herbal medicine. These are not covered by Buckeye Health Plan.
Generally speaking, any services that are deemed “not medically necessary” are not typically covered by Buckeye Health Plans.
Does Buckeye Health Plan cover online therapy?
Yes, Buckeye Health Plan covers both online therapy, also known as telehealth or virtual therapy, as well as in-person therapy.
Based on the state-specific insurance coverage, both telehealth and in-person therapies are only available in Ohio.
Does Buckeye Health Plan cover out-of-network therapy?
Buckeye Health Plan does not cover out-of-network therapists. Choosing to see an out-of-network mental healthcare provider with Buckeye Health Plan may result in significantly higher costs due to out-of-pocket charges compared to in-network providers.
If you have questions about out-of-network therapy coverage, please refer to your Buckeye Health Plan summary of benefits (SOB) as described below, or contact Buckeye Health Plan directly.
Search for therapists who accept Buckeye Health insurance
How to check if your Buckeye Health Plan plan covers therapy
There are two main ways to find out if your Buckeye Health Plan plan covers therapy and, if so, what it covers and how much it will cost.
1. Check your Buckeye Health Plan “Summary of benefits”
On the summary of benefits, look for a row that references mental health, behavioral health, or substance abuse services. It is also helpful to check “outpatient services” because therapy is considered to be outpatient care.
If the “Network Provider” and/or “Out-of-Network Provider” say “not covered”, then your Buckeye Health Plan plan does not cover mental health services such as therapy. On occasion, prior authorization may be required.
To learn more about how the Summary of Benefits is structured, you can refer to this sample SOB from the Centers for Medicare and Medicaid Services website.
2. Contact Buckeye Health Plan directly
Contacting Buckeye Health Plan directly is the best way to get the exact information you need about what types of mental health care are covered.
To find contact information for Buckeye Health Plan, you can:
- Find the phone number to call, located on the back of your insurance ID card
- Use the Buckeye Health Plan website to log into your account, and either chat or email a Buckeye Health Plan representative directly
How much does Buckeye Health Plan therapy cost?
Most people who are insured by Buckeye Health Plan will either be fully covered by their plan, or have to pay a small copay amount. For most clients, the average cost of Buckeye Health Plan for therapy is roughly $40 per session, after the deductible has been met.
If you are insured by Buckeye Health Plan the cost of therapy will depend on your plan’s specific coverage—you should always confirm your out-of-pocket costs before your appointment.
Buckeye Health Plan therapy copay
When paying for therapy, your copay (or copayment) is an important cost you should know about.
The copay is a fixed amount you have to pay for each therapy session. Copays can vary depending on your plan, as well as the therapist you see. Buckeye Health Plan does not have copays for most services.
Here’s a more detailed breakdown of this information:
- There are no copays for Buckeye Health Pan’s Ohio Medicaid insurance
- Members enrolled in MyCare Ohio plan will receive mental health and substance abuse disorder treatment services with no copay
- For prescription medications, Buckeye uses a tiered copay system, however, most preventative prescription medications have no copays
If you have any doubts or questions about if you have to pay a copay, or what your copay is, you should reach out to Buckeye member services to support directly.
Does Buckeye Health Plan require a referral to see a therapist?
Members of a Buckeye Health Plan can access mental health services, including therapy from an in-network provider directly without needing a referral. Members can self-refer to certain standard services, such as individual counseling, without permission or referral from their primary care provider or from Buckeye.
For more information related to referrals or other inquiries, visit Buckeye Health Plan website.
How to find a therapist covered by Buckeye Health Plan
Finding a therapist who accepts Buckeye Health Plan insurance is not as difficult as you might think. Whether you’re seeking individual therapy, family counseling, or specialized behavioral health services, you can choose from one of three ways to get started.
1. Buckeye Health Plan directory of therapists
Using Buckeye Health Plan’s online directory can save you time and effort in finding a mental health provider. Instead of calling multiple providers to see if they accept your insurance, you can quickly and easily find in-network providers in your area with just a few clicks.
Use the “Find a Provider” option, and filter by location, provider specialty or category (i.e. behavioral health), and whether they are accepting new patients. Buckeye Health Plan partners with multilingual providers to ensure members can access healthcare, even if English is not their primary language.
2. Contact Buckeye Health Plan customer service
Another way to connect with a therapist covered by Buckeye Health Plan is by contacting customer service directly at 1-866-246-4359 (TTY: 711).
3. Use Grow Therapy
With Grow Therapy, you can search for mental health providers who are in-network with Buckeye Health Plan, who are licensed in your state and provide both online therapy or in-person therapy. On Grow Therapy, you can browse our growing network of vetted therapists and use filters to search by age, specialty, gender, and more. Simply pick the therapist who meets your unique needs and book your first session.
When booking, you’ll be asked to enter your insurance information to verify eligibility and receive a cost estimate.
What do terms like deductible, copays, and coinsurance mean?
Navigating the insurance system—especially when you’re in need of mental health support—can be challenging and confusing. For help, please visit our Understanding Health Insurance article.
Navigating common issues with Buckeye Health Plan health coverage
Ensuring that your mental health services are covered and processed smoothly is essential for a stress-free experience.
Here are some common issues you might encounter with your Buckeye Health Plan coverage, along with effective troubleshooting tips to help you receive your services without any hassle.
Denied claims
In instances when your claim is denied, it is helpful to first check the explanation of benefits (EOB) or denial letter to understand the reason for denial.
Common causes of a denied claim include:
- Incorrect or missing patient information
- Lack of medical necessity
- Prior authorization issues (i.e. no referral)
- Duplicate claims
- Coverage issues
- Out-of-network providers
- Lack of documentation
If you feel this is something you have been wrongly denied for, and still require the services, the best solution is to submit an appeal.
Here is how to do this:
- Step 1: Gather documentation, including a letter from your mental health provider to explain why the treatment or intervention may be medically necessary
- Step 2: Submit a written appeal to Buckeye Health Plan within 60 days of receiving the notice of denial
- Step 3: Await a response, which will take 15 calendar days for standard appeals
If you need to request an expedited appeal, this can be processed within 72 hours.
Denied appeals
In cases where the appeal for your original claim has been denied, consider taking the following steps to reconcile this:
- Step 1: Request a state fair hearing within 120 days of the decision by contacting the Ohio Department of Medicaid
- Step 2: Seek independent external review which can be requested through Buckeye Health Plan within 180 days of the final denial notice
- Step 3: Maintain detailed records of all interactions made throughout the appeal process
Make sure to follow up regularly with Buckeye Health Plan to ensure your appeal is progressing.
Requiring pre-authorization for mental health services
Pre-authorization, also known as prior authorization, is required in some cases to allow Buckeye Health Plan insurance to review if treatment or medication is necessary and appropriate before approving the coverage.
You can use Buckeye’s Prior Authorization Check Tool to find out if the specific mental health service you’re seeking requires prior authorization. Keep in mind that the majority of in-network mental health services do not require pre-authorization.
For mental health services that require pre-authorization, members should ask their provider to submit a prior authorization request to Buckeye before the services are provided. This can be done through Buckeye’s provider portal or by fax.
Making the most of your mental health coverage with Buckeye Health Plan
Your mental health matters. With Buckeye Health Plan coverage, you can be one step closer to receiving a range of supportive services, from therapy to preventive care.
Check in on your plan regularly to stay informed about any changes in your Medicaid plan coverage. Having this preparedness can keep you from facing unexpected costs or gaps in care when you need support the most.
Mental health care is a priority that requires consistent attention and proactive management. By making it a focus, you can ensure you’re equipped with the tools and support needed to maintain your well-being. Consider alternative treatments and preventive care options, such as group therapies or mindfulness-based techniques to achieve the most comprehensive mental wellness.
