BCBS Insurance - Jackson Hole Counseling

We are only participating providers with BCBS

JH Family Solutions are participating providers with BlueCross BlueShield ONLY. Should this be your carrier, please complete the following form and we will check your benefits, track accumulations and file directly for you. Most policies do cover some mental health counseling.

Allow us to help you better understand your policy and get benefits. Should we NOT receive your information, then payment in full is required at time of service until we receive the benefit quote through submission of the form below.

Policy Holder Information
We will need all the information if you would like us to file to BCBS for services received, payments made.
Name of Policy Holder*
First Last
Policy Number*
WY BCBS starts with alpha-prefix followed by 12 digits Federal Policies start with R followed by digits Out of State policies may differ
Address of Policy Holder*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of birth of Policy Holder*
MM slash DD slash YYYY
Phone of Policy Holder*
Employer associated with Insurance. IF SELF EMPLOYED OR SELF POLICY, please indicate if it is under your name, or a business name*
CLIENT INFORMATION - complete ONLY if person in therapy is DIFFERENT from Policy Holder.
If seeking couple's therapy, we file under the policy holder.
Name of CLIENT
First Last
Address of CLIENT
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of birth of CLIENT
MM slash DD slash YYYY
Phone of CLIENT
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As participating providers with BlueCross Blue Shield for over 12 years, we look forward to assisting you. Insurance benefits can be difficult to decipher and we are experts in understanding what coverage you have for individual counseling, marriage therapy, family therapy.

If you have an alternate insurance carrier, we do require payment at time of service. Upon request, we will then provide you with a monthly invoice (superbill) for you to submit to your carrier for direct reimbursement.

If you DO NOT have BlueCross BlueShield

If you do not have a BlueCross Blue Shield insurance plan and are insured through a different carrier, we recommend contacting your carrier to understand your benefits. We suggest asking the following questions:

What is my deductible for an OUT OF NETWORK provider (mental health services)
How much of my deductible has been met
Once deductible is met, what is coinsurance for an OUT OF NETWORK provider
Are there any exemptions on my policy regarding mental health counseling

We are always able to help you understand your policy.

We are only participating providers with BCBS

Policy Holder Information

CLIENT INFORMATION - complete ONLY if person in therapy is DIFFERENT from Policy Holder.

If you DO NOT have BlueCross BlueShield