Does Blue Cross Blue Shield Cover ABA Therapy?

Yes, Blue Cross Blue Shield generally covers the expenses for ABA therapy, under specific conditions.

For families seeking treatment for Autism Spectrum Disorder (ASD), understanding insurance coverage for Applied Behavior Analysis (ABA) therapy is crucial. Blue Cross Blue Shield (BCBS), as one of the largest insurance providers in the United States, plays a vital role in this scenario. This article provides an overview of how BCBS approaches ABA therapy coverage and what families need to know.

Blue Cross Blue Shield's Approach to ABA Therapy Coverage

ABA therapy, recognized for its effectiveness in treating ASD, can be a significant financial investment for families. BCBS coverage for ABA therapy is generally available, but it is subject to specific conditions and varies by state and plan.

Key Coverage Aspects:

• Medical Necessity: BCBS generally covers ABA therapy if it is deemed medically necessary. This typically requires a diagnosis of ASD from a doctor and a prescription for ABA therapy.
• Provider Credentials: BCBS may require that the ABA therapy be provided by a licensed or certified provider.
• Varied Coverage Limits: The extent of coverage, including the number of sessions and the cost-share, can vary depending on the specific BCBS plan and the state regulations​​.

Steps to Obtain BCBS Coverage for ABA Therapy

To access ABA therapy coverage through BCBS, families should follow a structured approach:

• Obtain an ASD Diagnosis: A formal diagnosis from a doctor is the first step.
• Review Your BCBS Plan: Understand the specifics of your plan regarding ABA therapy coverage.
• Choose an In-Network Provider: Select a provider who is licensed or certified in ABA therapy and is in-network with BCBS to maximize coverage.
• Consider Referrals: Some plans may require a referral from a doctor to an ABA therapy provider​​.

Conclusion

While BCBS offers coverage for ABA therapy, the specifics depend on the individual plan and state regulations. Families are encouraged to thoroughly review their BCBS plan, consult with healthcare providers, and select appropriate ABA therapists to ensure they receive the necessary support for their children with ASD.

FAQ

Q: Does every BCBS plan cover ABA therapy?

A: While BCBS generally covers ABA therapy, coverage specifics can vary based on the plan and state. It's important to review your individual BCBS plan for details.

Q: What criteria must be met for ABA therapy to be covered by BCBS?

A: BCBS typically requires a medical diagnosis of ASD and deems ABA therapy as medically necessary. The therapy must also be prescribed by a doctor and provided by a licensed or certified provider​​.

Q: Are there any age limits for ABA therapy coverage under BCBS plans?

A: Some BCBS plans might have age restrictions for ABA therapy coverage. It’s essential to check the specific terms of your plan for any such limitations.

Q: Can I choose any ABA therapist for treatment under BCBS coverage?

A: To receive the maximum coverage, it's advisable to choose an ABA therapist who is in-network with BCBS and meets the licensing or certification requirements​​.