If you have a Blue Cross card, you may be wondering, "Does Blue Cross cover a psychologist or a psychological assessment?" It's a good question to ask before you book. The honest answer is that it depends on your plan, the type of practitioner and the service. This guide explains what to check and what to ask, so you can plan with fewer surprises.
We're a counselling clinic, not an insurer, and we can't see your plan or promise what it pays. This article is general information only.
The short answer, and why it depends on your plan
Blue Cross doesn't have one set of benefits for everyone. Your employer, your group or the personal plan you bought decides what's included, how much is paid back and what the yearly limits are. Two people with Blue Cross cards can get different answers for the same session.
Four things usually decide whether a visit is covered:
The plan you have, whether through work, a group or on your own
The type of practitioner, such as a psychologist, social worker or psychotherapist
The service, such as therapy, couples counselling or an assessment
The wording and limits in your own booklet
CAMH notes that some plans only cover services up to a certain amount, and only for certain types of therapists. So it's wise to check before your first visit, not after.
Medavie Blue Cross and other Blue Cross brands
"Blue Cross" isn't a single company across Canada. Blue Cross of Canada's website describes not-for-profit Blue Cross organizations that grew up in different provinces. If your card says Medavie Blue Cross, its own website lets members pick a region, Ontario included.
That's why the first step is simple. Look at the name on your card and on your booklet. Then use that insurer's own information, because one Blue Cross organization can't speak for another's plans.
Where to look at your coverage
Medavie Blue Cross says that members can use its mobile app or its Member Services Site to search benefit details, view past claims and submit claims. Your booklet is the other source of truth. Medavie's mental health services page points members to the section of the booklet on mental health practitioners for the details.
Before you look, gather:
Your plan or group number and member ID
The practitioner type you want to see
The exact name of the service, such as therapy or an assessment
Then find the line for psychologists, social workers, counsellors or psychotherapists. Some plans list these together, with one shared yearly limit, and others split them up.
Psychologists, therapy and other practitioners
Plans group these in different ways. Medavie's published plan information, for instance, shows that the yearly limits for psychologists, social workers and counsellors vary from one plan to the next. We're not quoting any amounts here, because they belong to specific plans and change over time.
Titles matter too. The Ontario government's page on regulated health professions explains that psychologists can communicate a diagnosis and treat clients with psychotherapy, and that registered psychotherapists assess and treat through therapy. At our clinic, Registered Psychotherapists (RPs) and Registered Social Workers (RSWs) provide therapy, and our psychologists can assess and diagnose.
If you want to see how this works for social workers, our page on Medavie Blue Cross and social workers covers that profession. This post looks at psychologists, therapy and assessments more widely.
If you prefer online sessions
Many people ask whether virtual visits count. Medavie Blue Cross has a page on online health services. It says that if your plan includes coverage for a practitioner type, you can claim virtual visits with that type, and its list includes psychologists, psychotherapists and social workers. It adds that claims follow your plan's rules.
We offer online sessions across Ontario. As with in-person visits, the best step is to confirm with your insurer that your plan applies to the service and the title of your practitioner.
Psychological assessments, and what to ask
An assessment is different from weekly therapy. In Ontario, psychologists assess and diagnose. Whether your plan pays for an assessment depends on how it's worded, and some plans treat assessments differently from therapy. We can't tell you which applies to you.
The word "assessment" can cover a lot. NIMH explains that an adult ADHD evaluation may include clinical interviews, rating scales, symptom checklists and psychological tests. A plan might pay for all of it, some of it or none of it.
When you check, use the exact name of the service, then ask:
Does an assessment count toward my psychologist line?
Does it share a yearly limit with therapy?
What details must the receipt show?
Do I need any extra paperwork?
Medavie Blue Cross lists the documents it may ask for when you submit a claim. A receipt is always needed, and some benefits may also need an itemized statement of services. Our adult ADHD assessment page explains what we offer. Assessment fees depend on the service, and we go over them with you in the free consultation.
Claiming and direct billing
There are two common ways to use your benefits. With pay-and-claim, you pay us and send the receipt to the insurer. With direct billing, the clinic bills the insurer, and you pay only what your plan doesn't cover.
Medavie Blue Cross says a provider can send a claim directly through its ePay service, or a member can send in a receipt through the app or the Member Services Site. It also says claims are subject to your plan and to its reasonable and customary limits, which means your plan may recognize less than the full fee.
We can direct bill many plans, and we'll confirm what's possible for yours before your first session. Depending on your plan, your insurance may cover the full session fee. We can't promise direct billing for every plan or every member. Our page on direct billing explains how it works.
Medavie's claim page also says health services must be provided by a Medavie Blue Cross-approved health professional to be eligible. That wording is worth a question. Ask your insurer how it applies to the title your therapist or psychologist holds, and bring the answer to your free consultation if you'd like help sorting it out. We can walk through it with you, step by step.
Questions to ask before you book
Whether you call your insurer or check your account, these questions help:
What's the name of the insurer on my card, and which booklet applies to me?
Which practitioner types are covered, and do they include psychologists, RPs and RSWs?
Is there a yearly maximum, and how much have I used?
Is the exact service covered, whether therapy, couples therapy or an assessment?
What do you mean by "reasonable and customary" for my session fee?
What must a receipt show, and is there a deadline to claim?
Can the clinic bill you directly, or do I pay and claim?
Write down the answers and the date you asked. If something is unclear, it's fine to ask again or to ask for it in writing. Plans can be confusing, and you're not expected to be an expert in how yours is worded. It also helps to keep a simple file with your receipts and your notes, so you can find them if you need to follow up.
What therapy costs at our clinic
Knowing our fees helps you work out your share. Individual sessions are $130 to $200, and couples or family sessions are $170 to $200. Student therapists offer sessions for $0 to $80, and we accept Health Spending Accounts. There's a $50 one-time new client setup fee, which isn't charged for the free consultation. Psychologist fees depend on the service, and we explain them in the free consultation.
Next step, a free consultation
You don't have to sort this out alone. Book a free 15-minute consultation to ask about our team, our fees and how billing works. Our team can help you check your card before your first session. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario.