2022 Blue Cross Blue Shield Coverage

The Blue Cross Blue Shield Association provides health insurance to more than 100 million people across the United States. Blue Cross provides hospital service coverage, while Blue Shield covers doctors’ services. 

The Blue Cross Blue Shield Association is an alliance of different health insurance businesses covering people in each state. Each company is independently operated and locally owned, selling services relative to their home states/regions. 

Blue Cross Blue Shield remains America’s most popular health insurance company, with high ratings and good reviews from its customers.

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BCBS Operating States

According to the BCBS website, “The 34 independent and locally operated Blue Cross Blue Shield companies deliver health insurance coverage to one in three Americans across all 50 states, the District of Columbia and Puerto Rico.”

BCBS Health Insurance Offerings Overview

Does Blue Cross Blue Shield Cover Acupuncture?

Generally, Blue Cross health plans cover acupuncture if prescribed by a primary care practitioner (PCP) and deemed medically necessary. This may be due to chronic pain that has lasted at least six months and has not responded to other treatment, such as medication or physical therapy, or for nausea resulting from surgery or chemotherapy. 

Coverage limitations for acupuncture vary from state to state, so make sure to check with your provider to determine whether acupuncture will be covered for you. 

Please be weary of receiving acupuncture treatment if you are pregnant, have a pacemaker, or take blood thinners.

Does Blue Cross Blue Shield Cover Chiropractic Services?

Yes, Blue Cross Blue Shield covers chiropractic services when they are determined medically necessary. Common chiropractic treatments include therapeutic exercise and stretching, spinal traction, and transcutaneous electric nerve stimulation (TENS), among others.

In most cases the individual must have clinical symptoms of a condition that may be improved or resolved by standard chiropractic therapy. For full coverage, a treatment plan must be clearly documented, the chiropractic procedures must be clearly related to the patient’s condition, and the chiropractic care must be performed by a licensed chiropractor.

Does Blue Cross Blue Shield Cover Allergy Testing?

Blue Cross Blue Shield will cover allergy testing when determined to be medically necessary. Certain allergy testing procedures, such as routine re-testing, may not be covered. 

Allergy testing and desensitization injections can be a great way to determine allergies and prevent bad reactions if determined to be medically necessary by the Primary Care Physician. Allergy testing and immunotherapy are covered if you are referred by your physician.

Does Blue Cross Blue Shield Cover Abortions?

Some job-based health plans cover elective abortions. Patients can search their plan documents or call their insurers directly to check.

However, due to the recent overturning of Roe v. Wade, no American insurance companies cover abortions or abortion-related treatments. 

Does Blue Cross Blue Shield Cover Gender Reassignment Surgery?

In some states, Blue Cross Blue Shield covers gender reassignment surgery, when such surgery is considered medically necessary for the treatment of gender dysphoria. Other criteria or assessments might be evaluated for surgery consideration. 

As an example, according to BCBS of North Carolina, criteria for adults age 18 years and older for gender affirmation surgery include:

  • The candidate is at least 18 years of age
  • The candidate has been diagnosed with gender dysphoria, including meeting all of the following indications
    • A strong conviction to live as some alternative gender different from one’s assigned gender
    • The desire to make the physical body as congruent as possible with the identified sex through surgery and hormone treatment
    • The affirmed gender identity has been present for at least 6 months
    • If significant medical or mental health concerns are present, they must be reasonably well-controlled
    • The gender dysphoria causes clinical or social distress or impairment in social, occupational, or other important areas of functioning

Does Blue Cross Blue Shield Cover Birth Control?

Blue Cross Blue Shield includes coverage for birth control, including oral contraceptives, intrauterine devices, injections, and emergency contraception. Coverage may depend on the type of plan you are enrolled in. 

To view a full list of birth control options that Blue Cross Blue Shield can cover, click here

Does Blue Cross Blue Shield Cover Breast Reduction?

Breast reduction surgery, also known as reduction mammoplasty, is covered by Blue Cross Blue Shield if considered medically necessary. 

Several criteria must be met, including a diagnosis of macromastia, the diagnosis of two or more symptoms of hypertrophy (backache, posture change, hygiene problems, or other), and the failure to relieve symptoms using nonsurgical treatment (including exercise, hot/cold treatment, and an appropriate support bra) for at least six weeks. Patients must also be at least 18-years-old  or must have reached breast maturity. 

Does Blue Cross Blue Shield Cover Infertility Treatment?

Blue Cross Blue Shield covers infertility when it is categorized by a primary care practitioner (PCP) or obstetrician-gynecologist (OB GYN) as medically necessary. 

Diagnostic tests, including tests to rule out endocrine causes of infertility and semen analysis, among other tests, must be performed to determine that infertility treatments are necessary. Treatments may include infertility drugs and operative procedures, but coverage frequently excludes artificial means of conception, such as artificial insemination and in vitro fertilization (IVF). 

Does Blue Cross Blue Shield Cover STI/STD Testing?

Some STI testing, including screening for HIV, syphilis, gonorrhea, and Hepatitis A and B, are covered by Blue Shield Blue Cross for both sexually active men and women when it is deemed medically necessary. 

This may include testing as part of a pregnancy screening, testing for individuals who are deemed high-risk, testing for victims of sexual assault, or routine testing for homosexual men. 

Testing for certain STDs — like HIV, syphilis, chlamydia, and gonorrhea — is one of most effective preventive health benefits that most health plans cover.

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BCBS Mental Health Insurance Overview

Does Blue Cross Blue Shield Cover Mental Health Services? 

Blue Cross Blue Shield covers a variety of mental health services, treatments, and medications through its various company’s coverage.The three main treatments covered by Blue Cross Blue Shield are harm-reduction, medication management, and therapy.

It is important to note that evidence-based treatment, like therapy and psychoanalysis, is covered, but services rendered outside of a therapy setting, such as systematic desensitization or exposure therapy for a specific phobia, are typically not covered. 

Contact your state’s Blue Cross Blue Shield to see what can be covered for your mental health treatment.

Does Blue Cross Blue Shield Cover therapy costs?

Yes, many Blue Cross Blue Shield plans cover therapy, often focusing coverage on evidence-based therapeutic services, such as psychoanalysis. It’s best to clarify coverage with your provider directly by phone. 

Therefore, traditional therapy, like in-office cognitive behavioral therapy, hypnosis,or talk therapy will most likely be covered, but out-of-office therapy may not be.

BCBS Dental Insurance Overview

Does Blue Cross Blue Shield Cover Annual Dental Costs?

Most Blue Cross Blue Shield insurance providers offer add-on plans to cover dental care. These plans can include preventive packages, which cover procedures such as routine cleanings, and more comprehensive packages that cover minor and major services and procedures, like fillings and dental surgeries. These dental plans must be purchased separately from traditional medical coverage.

As of 2022, Blue Cross Blue Shield covers:

  • Periodontal maintenance 
  • Periodontal scaling/root planing 
  • Periodontal and oral evaluations 
  • Palliative treatments 
  • Fluoride and sealants 
  • Extensive removal of plaque and tartar buildup (full mouth debridement)

(Source)

Does Blue Cross Blue Shield Cover Braces?

Some Blue Cross Blue Shield dental plans offer coverage for orthodontic needs. Review the various dental plans to determine which plan includes your specific needs.

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans – and, unfortunately, braces can fall under the cosmetic category. It is best to check with your insurer to see if you will be covered for braces. 

Does Blue Cross Blue Shield Cover Braces For Adults?

Some Blue Cross Blue Shield dental plans offer coverage for orthodontic needs, including braces for adults. Review the various dental plans to determine which plan includes your specific needs. 

The rules for braces coverage under Blue Cross Blue Shield are the same for children as they are for adults – since braces or invisible liner treatments can be considered a cosmetic surgery instead of preventive or basic treatment, they may not be covered. Check your plan and your region’s policies to be sure.

Does Blue Cross Blue Shield Cover Dental Surgery?

Blue Cross Blue Shield dental plans provide some coverage for dental surgery. Depending on the plan, the amount of coverage offered can vary. 

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans.

Does Blue Cross Blue Shield Cover Wisdom Teeth Removal?

Wisdom tooth removal is covered by Blue Cross Blue Shield dental plans, as it is a necessary surgery that can prevent health complications later on. 

Does Blue Cross Blue Shield Cover Dental Implants?

Some Blue Cross Blue Shield dental plans provide coverage for dental implants. Review the various dental plans to determine which plan includes your specific needs and consult your state’s individual BCBS company to learn more. 

Dental implants can sometimes be sought out for purely cosmetic reasons, so you may have to check with your plan to see if they will cover your specific implants and the reason why you’re getting them. 

BCBS Vision Insurance Overview

Does Blue Cross Blue Shield Cover Lasik?

Some Blue Cross Blue Shield vision plans, which can be purchased separately from traditional medical insurance, offer a discount on LASIK eye surgery. The LASIK discount is usually between 15-25%, depending on the state.

Typically, no third party insurers or governmental insurers cover the surgery, but they can offer a discount or rebate.

Does Blue Cross Blue Shield Cover Cataract Surgery?

Cataract surgery using the monofocal intraocular lens is covered by Blue Cross Blue Shield. Review the individual vision plan to learn alternative coverage for cataracts. 

Blue Cross Blue Shield Medicare Advantage plans cover cataract surgery, as it’s covered by Original Medicare and seen as a necessary medical procedure. 

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BCBS Prescription Drug Insurance Overview

Does Blue Cross Blue Shield Cover Hearing Aids?

Coverage for hearing aids can typically be collected through a Blue Cross Medicare Supplement or Legacy Medigap plan. 

Blue Cross Blue Shield typically doesn’t cover hearing aids in many of its standard insurance plans (like HMO and PPO), but it does offer supplemental options for its Medicare plans.

Does Blue Cross Blue Shield Cover Blood Pressure Monitors?

Some Blue Cross Blue Shield plans may cover blood pressure monitors when they are considered medically necessary (for instance when there’s a diagnosis of hypertension). 

In other instances, blood pressure monitors are covered by the Blue Cross and Blue Shield Federal Employee Program. Check with your state’s coverage for more details. 

Does Blue Cross Blue Shield Cover Cialis?

Blue Cross Blue Shield covers Cialis if it is determined medically necessary. Alternative prescription drugs are often covered as well. 

A patient must have a diagnosis of erectile dysfunction or benign prostatic hyperplasia, among other criteria, in order for coverage to apply. 

Does Blue Cross Blue Shield Cover Chantix?

Chantix is a smoking cessation treatment that helps people addicted to nicotine curb their cravings and kick the bad habit. Chantix is covered by Blue Cross Blue Shield.

However, in case of a recall occurring, Blue Cross Blue Shield will also cover other smoking cessation treatment replacements

Does Blue Cross Blue Shield Cover the Shingles Vaccine?

Most Blue Cross Blue Shield plans cover Zoster or Shingrix, both shingles vaccines, for individuals aged 60-years and older, or 50-years and older respectively.  

Shingrix is a vaccine made of a shingles virus component. It’s given in two doses, with 2-6 months between doses. Because you have to repeat treatment, it is great that the cost is covered.

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