BHS Mental Health Coverage in Michigan: Therapy & Testing Benefits
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BHS mental health coverage in Michigan can feel complex because benefits vary by employer group, network tier, and whether services are billed as medical or behavioral health. Understanding your plan’s network status, cost-sharing rules, and authorization requirements helps you avoid unexpected bills and care delays. This guide explains how BHS benefits commonly work for therapy, counseling, and testing in Michigan, with practical steps to verify coverage online. Information below is educational and should be confirmed against your specific plan documents.
Understanding Your BHS Mental Health Benefits
In Michigan, BHS plans (and BHS-administered behavioral health benefits) typically distinguish between In-Network and Out-of-Network providers, and that distinction can change the allowed amount, your out-of-pocket costs, and whether you need prior authorization. In-Network means the clinician or clinic has a contracted rate with BHS; your claim is usually paid at the highest benefit level, the provider generally accepts the allowed amount, and your cost is commonly limited to a co-pay or co-insurance plus any deductible. Out-of-Network means there is no contracted rate; reimbursement may be lower (or not available), you may face a separate out-of-network deductible, and you can be balance billed for the difference between the provider charge and what BHS allows—if your plan permits out-of-network benefits at all.
- Is my provider in-network for my specific plan (not just “BHS in general”)? Confirm the exact network name and whether mental health is managed under a separate behavioral health network.
- What are my in-network and out-of-network costs for outpatient psychotherapy? Verify deductible status, co-pay vs. co-insurance, and whether your plan uses “mental health office visit” cost-sharing or a different tier.
- Do I need prior authorization or a referral for therapy or testing? Ask which services require authorization, who submits it, and whether certain diagnoses or testing types trigger medical-necessity review.
BHS Coverage for Therapy & Counseling
BHS mental health benefits in Michigan commonly include outpatient psychotherapy and counseling when services are medically necessary and delivered by an appropriately credentialed provider (for example, psychologists, clinical social workers, professional counselors, or marriage and family therapists, depending on your plan). Evidence-based talk therapies such as CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavior Therapy) are often covered under standard psychotherapy billing when documentation supports the diagnosis, treatment plan, and measurable goals.
Patient cost typically depends on whether you have met your deductible and whether your plan uses a co-pay (a fixed dollar amount per visit) or co-insurance (a percentage of the allowed amount). Many Michigan employer plans apply a deductible first, then co-insurance; others apply a mental health office-visit co-pay without a deductible (or with a separate behavioral health deductible). To minimize denials and reprocessing, ensure the claim aligns with the correct place of service (office vs. telehealth), the rendering provider credential, and the correct dates and session length documentation when applicable.
Michigan patients should also verify whether their plan has any utilization management rules, such as periodic clinical review after a certain number of sessions. While the federal Mental Health Parity and Addiction Equity Act generally requires mental health benefits to be comparable to medical/surgical benefits, practical differences can still arise through network design, prior authorization rules for specific services, and how “medical necessity” is applied. The most reliable approach is to confirm your exact cost-sharing and authorization requirements through your plan’s online portal and your Summary of Benefits and Coverage (SBC).
Psychological vs. Neuropsychological Testing Coverage
Testing is frequently covered by Michigan BHS plans when it is medically necessary, clinically indicated, and used to answer a specific diagnostic or treatment question (for example, differentiating ADHD from anxiety, clarifying learning or memory concerns, or informing treatment planning). However, testing is also one of the most common areas for claim denials because carriers often require prior authorization and detailed documentation showing why testing is needed beyond clinical interview and rating scales. Prior authorization requirements may apply to both psychological and neuropsychological testing, and many plans require submission of a testing request that includes presenting concerns, history, prior treatment, requested test battery rationale, and how results will guide care.
From a billing perspective, successful coverage hinges on aligning the request with the carrier’s medical policy and documenting functional impairment and treatment impact. Common carrier requirements include recent clinical evaluation notes, a clear referral question, and evidence that results will change care planning (medication management, school/work accommodations, rehabilitation planning, or specific therapy targets). In Michigan, if authorization is required and not obtained, claims may be denied as “no authorization” even when the testing is clinically appropriate.
Frequently Asked Questions for BHS Members
Will my employer see my diagnosis?
In most situations, your employer does not receive your diagnosis or therapy notes. Under HIPAA and related privacy laws, protected health information is generally shared only for payment, treatment, and healthcare operations, and access is limited to what is necessary. Employers that sponsor insurance plans may receive aggregated or de-identified utilization reporting, but individual clinical details are not typically disclosed. If you use an employer-sponsored plan, your Explanation of Benefits (EOB) may include service dates and general service descriptions, and in some cases diagnostic codes; who can view the EOB depends on the policyholder arrangement (for example, if you are covered as a dependent). For the strongest privacy protection, review how your insurer delivers EOBs (paper vs. digital), confirm portal access settings, and ask about confidential communications options available under your plan.
Does BHS cover telehealth in Michigan?
Michigan telehealth coverage is influenced by state-specific rules and the terms of your BHS plan, including network participation and medical necessity standards. Many Michigan health plans cover telehealth for outpatient mental health when the provider is appropriately licensed and the session is billed with correct telehealth indicators. Coverage can still vary by plan type (commercial employer plan vs. other product lines), and some plans may apply the same cost-sharing as in-person visits, while others apply different cost-sharing depending on place of service or the platform used. To avoid claim issues, verify (1) whether your plan requires a specific telehealth platform, (2) whether the provider must be in-network for telehealth to be covered, and (3) whether telehealth visits are subject to the same deductible/co-pay and authorization rules as in-office visits.
Call to Action: Visit the Michigan Psychologists contact page to verify your BHS benefits through our secure portal.