Does Blue Cross Blue Shield cover ABA therapy?

Yes, Blue Cross Blue Shield (BCBS) generally covers ABA therapy for children with ASD, recognizing it as a medically necessary treatment. Coverage details, however, can vary based on the specific plan and state regulations.

Key points to consider are:

• Medically Necessary Treatment: ABA therapy is typically covered as it’s considered essential for treating ASD.
• Plan and State Variations: Coverage for ABA therapy may differ in terms of session limits, age restrictions, and prior authorization requirements, depending on your specific BCBS plan and state.
• Prior Authorization: Many plans require approval from BCBS before starting ABA therapy. Coordination with your healthcare provider for this authorization is crucial.
• Session and Age Limits: Some BCBS plans may impose limits on the number of therapy sessions or cover therapy only up to a certain age.
• Out-of-Pocket Costs: Despite coverage, families might incur out-of-pocket expenses like deductibles, copays, or coinsurance.

To fully understand your coverage, it’s advisable to review your BCBS plan details or contact their customer service. Our team is also here to answer any insurance questions and guide you through the process.