Mental Health and Substance Abuse Treatment Forms

For your convenience, here are mental health and substance abuse benefits forms for Companion Benefit Alternatives, Inc. (CBA). On behalf of BlueCross BlueShield of South Carolina, CBA administers mental health and substance abuse benefits. CBA is a separate company.

Outpatient Treatment Forms

Outpatient Treatment Initiation Form
Outpatient Treatment Continuation Form
Network Outpatient Treatment Report
South Carolina Non-Network Outpatient Treatment Report

Substance Abuse Treatment Forms

Outpatient Substance Abuse Treatment Request Form
Outpatient Substance Abuse Treatment Request Form: Continued Stay

Electroconvulsive Therapy Forms

Electroconvulsive Therapy Initiation Request
Electroconvulsive Therapy Continuation Request

Please note: The State Health Plan provides Mental Health and Substance Abuse coverage through APS Healthcare, Inc. APS Healthcare, Inc. is an independent company that does not offer BlueCross BlueShield of South Carolina products or services. APS Healthcare, Inc. is solely responsible.