Thursday, June 20, 2024

Blue Cross Blue Shield Autism Coverage

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Anthem Blue Cross and Blue Shield offers Medicare Advantage plans with Essential Extras

A confidential and secure service available

We are proud to support the well-being of our clients by offering them virtual health care included free of charge with select Ontario Blue Cross® health insurance plans.

Thanks to this service, our clients can benefit from immediate medical support from their computer or mobile device, without leaving home.

Behavioral Health Treatment For Medi

Blue Shield of California Promise Health Plan covers Behavioral Health Treatment , including Applied Behavior Analysis therapy, for Medi-Cal beneficiaries under the age of 21. Blue Shield Promise manages this benefit directly.

Referrals for BHT or ABA treatment for a member should not be sent to the member’s medical group or IPA. A primary care physician or healthcare provider will follow the screening process below.

If a provider believes the member may have autism spectrum disorder , based on screening outcomes, the provider should submit a diagnostic evaluation referral for ASD to Blue Shield Promise. If a provider believes a member is likely to benefit from BHT or ABA services, the provider can submit a referral for treatment to Blue Shield Promise.

A diagnosis of autism spectrum disorder is not required for the member to be eligible for BHT or ABA treatment. Please refer to from Department of Health Care Services for more information.

Federal Employees Health Benefits

The Federal Employees Health Benefits Program is the nation’s largest employer-sponsored health benefits program. The FEHB Program is administered by the U.S. Office of Personnel Management .

It provides healthcare coverage to 8.2 million federal employees, retirees, and dependents.

Effective January 1, 2017 all FEHB plans are required to cover Applied Behavior Analysis for the treatment of autism. For more information, please see ABA Coverage in FEHB for 2017: Questions & Answers on the OPM website.

If you are covered by an FEHB plan that does not provide coverage for ABA, please contact us at .

To the best of our ability, this information is accurate and up to date, but it is up to the consumer to investigate fully before making any decisions regarding health care coverage.

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How To Verify Bcbs Autism Coverage

Athena Care is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the easiest and quickest method to determine if your Blue Cross Blue Shield Autism treatment or testing is covered.

Let our highly experienced, expert care coordinators handle the difficulties of contacting your insurance carrier for more information about BCBS coverage for Autism treatment. After completing the form, a care coordinator will review your policy and thoroughly explain your options. Rest assured, all submitted or discussed information is kept confidential.

How To Obtain Coverage

Funding Sources â BIA

The MIT health plans cover ABA services for covered dependents to diagnose and treat autism spectrum disorders with a pre-authorization from Blue Cross Blue Shield.

To obtain a pre-authorization, your provider must contact the Blue Cross Blue Shield Behavioral Healthcare Coordination line at 1-800-524-4010. The provider will then need to provide the member’s name, date of birth and Blue Cross ID#, as well as their own name, address and NPI number.

Since most ABA providers are out-of-network, they may not bill Blue Cross directly. Therefore, most providers will ask that you pay for ABA services out-of-pocket. You can then submit a Subscriber Claim Form directly to Blue Cross Blue Shield for reimbursement, less the $20 per visit copayment, which you will be responsible to pay.

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Does Blue Cross Blue Shield Cover Aba Therapy

Yes, ABA therapy is covered under most Blue Cross Blue Shield plans.

Case managers at Blue Cross Blue Shield can assist you in finding an in-network provider who matches your child’s needs. Most Blue Cross plans cover or assist pay for services to treat ASD for children under the age of 18. These plans include Fully Insured Plans , Administrative Services Only plans, etc.

How Much Does Autism Testing & Treatment Cost Without Insurance

The following are average costs, though they may vary by location and other variables and may not reflect the actual cost of what youll pay for testing or treatment.

Doctors visits alone can range from a few hundred dollars to more than $2,700. In the United States, the typical cost of psychotherapy ranges from $100 to $200 a session, dependent upon the state and the length of the session.

The cost of a supply of 30 count Risperidone 1 mg oral tablets is roughly $18,9 and the average price of ABA is $120 an hour. Some children require up to 40 hours of ABA therapy every week to reach their full potential, which amounts to $4,800 per week or $249,600 per year.9

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Federal Employee Program Applied Behavior Analysis

The Federal Employee Program covers outpatient treatment therapies for Applied Behavior Analysis for the treatment of an autism spectrum disorder. Prior approval is required for ABA and all related services, including assessments, evaluations and treatments. FEP ABA services are eligible with place of service home and office.

Applied behavior analysis services and related services performed as part of an education program or provided in or by a school educational setting or provided as a replacement for services that are the responsibility of the education system are not covered under the Federal Employee Program. Applied behavior analysis and related services for any condition other than an autism spectrum disorder are not covered under the Federal Employee Program.

Please contact the Blue Cross Blue Shield of North Dakota Federal Employee Program at 1-800-548-4026 with any questions.

Benefits Of Blue Cross’s Behavioral Therapy Coverage

Here for it All | Blue Cross Blue Shield of Michigan

Here are some common autism benefits covered by Blue Cross:

  • Applied Behavior Analysis therapy
  • Occupational, speech, and physical therapy
  • Nutritional counseling
  • Some treatment for autism could be fully or partially covered by Blue Cross depending on your individual plan.

    Some employers are able to personalize the programs they provide, and they could alter which benefits are included in your insurance plan.

    The most important thing your family could do before receiving treatment services is to check your insurance coverage.

    ABA therapy is costly if paid out-of-pocket, so make sure to confirm with your insurance provider that they can cover costs either partially or fully.

    Blue Cross needs to receive a request from members which is sent by the ABA therapy provider. In the pre-authorization procedure, the first step will be to confirm if:

  • The provider is qualified to provide ABA therapy.
  • The member has ABA therapy coverage.
  • The initial therapy plan meets is medically necessary for the child.
  • The member has been diagnosed with autism by a certified diagnostician.
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    Autism Spectrum Disorders Mandate

    We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex, including sexual orientation, gender identity, or gender expression. We also provide language assistance. Read our Nondiscrimination and Language Assistance notice.

    All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

    How To Find Bcbs Autism Testing & Treatment Clinics Near Me

    With Athena Care, gaining access to Autism testing clinics in Tennessee has never been easier. A care coordinator can assist you with any questions or concerns about Blue Cross Blue Shield Autism coverage at one of various Tennessee locations. Athena Care health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m.

    When choosing Autism doctors or care providers, its important to keep the following in mind:

    • Education, training, license, and years of experience
    • Specialties and services offered
    • Insurance companies they work with

    Also, dont be afraid to ask questions.

    Here, youll find a list of practitioners organized by city and information about their backgrounds and specialties.

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    How To Benefit From Virtual Health Care

    Eligibility requirements

    Virtual health care is available free of charge to eligible Ontario Blue Cross® clients* with:

    • Disability insurance .

    *If your policy number starts with 19XXX, click here to see the list of eligible products. For all other policies, click here.

    To access TELUS Health Virtual Care service, you must have one of the following products:
    Blue Choice®, Blue Choice Balance, Basic Blue Choice, Basic Plus +
    Blue Vision®
    Express Plan Health Package

    1. Eligibility:

    • The primary insured for individual contracts.
    • The primary insured, their spouse and their dependent children for family-type contracts.
    • All persons insured under a Mortgage Plan contract as well as their spouse and dependent children.

    Not all contracts provide access to the virtual health care service. Please refer to the list of eligible products available on

    2. Activation and duration of membership:

    Each eligible person has access to the virtual health care service on the effective date of the benefit on the contract providing eligibility, as long as the benefit giving them access to the service is in force. Access to the service ends on the date on which the benefit providing eligibility ends, or for family-type contracts, on the date on which the person no longer has the status of spouse or dependent child.

    3. Waiver:

    4. Applicable laws:

    This program is governed by the laws of the province of Ontario and the applicable Canadian federal laws.

    7. Service:

    Does Blue Cross Blue Shield Cover Autism Testing & Treatment

    Funding Sources â BIA

    Yes, Blue Cross Blue Shield of Tennessee health insurance covers Autism testing and treatment under Tenn. Code Ann. § 56-7-2367.1 Autism spectrum disorder is classified as a neurological illness under the legislation. Contracts and insurance that provide benefits for neurological illnesses must include benefits and coverage for autism therapy for children under 12.

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    What Do I Need To Know About Autism Coverage

    Who is this for?

    Blue Cross Blue Shield of Michigan and Blue Care Network members

    Most Blue Cross plans cover or help pay for services that treat autism spectrum disorders for members. Standard autism benefits include:

    • Applied behavior analysis, or ABA
    • Physical, speech and occupational therapy
    • Nutritional counseling

    Your plan may have requirements before it covers or helps pay for some services. Certain employers can customize the plans they offer. They may change which autism benefits are included, what you need to do to get them, or choose to omit them.

    Thats why the most important thing you should do before getting services is check your coverage.

    Find Your Plans Autism Coverage

    The easiest way is to log in to your member account. You can do that using our website or the Blue Cross mobile app.

    After logging in, go to My Coverage, select Medical and then Whats Covered. Look for autism. In that section youll get information about:

    • Plan requirements for getting services
    • The kinds of services your plan will help pay for
    • How much you pay and your plan pays

    Blue Care Network HMO members: If you see in Whats Covered that your plan includes autism coverage, you should also check your Certificate of Coverage. It will have a lot more information. You can find your Certificate of Coverage in your member account:

    • On our website, go to My Coverage, select Medical, then Plan Documents
    • On the app, go to My Coverage, select Medical then scroll down to Certificates and Riders

    Dont see autism listed or have questions about autism coverage?

    • Members who get insurance through an employer: Talk to your HR department or whoever handles your benefits
    • Or, call the Customer Service number on the back of your Blue Cross ID card and well help

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    Does Blue Cross Blue Shield Cover Autism Testing

    Blue Cross Blue Shield Autism assessments may be covered depending on your specific insurance plans benefits.

    Because there is no medical test for Autism Spectrum Disorder , such as a blood test, diagnosing the illness can be difficult. To diagnose, doctors look at the childs developmental history and behavior.

    Developmental monitoring examines how your child develops and evolves and whether they fulfill developmental milestones in areas such as playing, learning, speaking, acting, and moving. Parents, grandparents, early childhood providers, and other caregivers can conduct developmental monitoring.

    Developmental screening examines your childs development in greater detail. A quick test will be given to your child, or you will be asked to fill out a questionnaire about your child. A doctor or nurse and other experts in the healthcare, community, or educational sectors can perform developmental screening.

    Autism can be discovered as early as 18 months of age. Therefore, a diagnosis by an experienced professional by the age of two can be considered reliable. Many, however, do not obtain a definitive diagnosis until they are considerably older.5

    Let Vista Tell You How To Get Started Looking Into Autism Insurance Coverage

    Las Vegas autism center may be forced to drop insurance

    Are you a candidate for getting health insurance coverage for autism treatment? Answer these questions:

    • Do you live in California?
    • Has your loved one received a prescription for behavioral health treatment from a physician or a licensed psychologist?
    • Do you have a fully funded health insurance plan that has a behavioral health component?

    If you answered YES to these questions, you may qualify for coverage for medically necessary behavioral health treatment, particularly including Applied Behavior Analysis.

    We understand this process and we will help you to navigate the complex insurance system. Please let us apply our knowledge and experience to educate you about getting insurance coverage for your loved ones ABA therapy.

    Also Check: How Does Autism Affect People

    Applied Behavioral Analysis Therapy Benefits For Publix Members

    Effective as of January 1, 2019, Applied Behavioral Analysis therapy benefits are now available to Publix members. Our ABA therapy program is designed to assist members and families who have children with autism spectrum disorder .

    Our ABA therapy benefits are managed by a dedicated coordinator through the Publix plans case management program, which is administered by Companion Benefit Alternatives .

    ABA therapy covers specific services for members with ASD. ABA involves a treatment team made up of a certified technician and a qualified health professional to provide behavioral therapy.

    Although our ABA therapy program does not include speech, physical or occupational therapy, these benefits are still covered under the Publix medical plan.

    Precertification Required

    Precertification by CBA is required for ABA services. An initial request for ABA therapy requires a treatment plan, signed and submitted by a licensed physician.

    Florida Blue will not provide coverage for ABA therapy services until you receive approval through the preauthorization review process.

    For detailed preauthorization requirements, or for more information about ABA therapy benefits, contact the ABA project coordinator at 1-800-868-1032, ext. 25634, or

    Details Of Californias Legislation For Autism Insurance

    California Insurance coverage for individuals with ASD has been mandated with the Legislatures passage of SB 946 and it will go into effect July 1, 2012. SB 946 requires fully funded insurance plans to cover medically necessary autism treatments and it specifically includes the only scientifically-proven procedure, ABA. This law compliments and strengthens Californias AB 88 law which was passed in 2000. Also known as the Mental Health Parity Act , AB88 requires insurance companies to offer treatments for autism along with other disorders.

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    Provider Lists By Network

    Note: The lists below may contain outdated information or not include all plans offered by Blue Cross NC. Please check back soon for updated and current lists. Because medical practices often change providers and services, Blue Cross NC is unable to guarantee that the providers listed below currently offer Autism services. Please call the provider to confirm before you make an appointment.

    Blues Release More Detail On Autism Benefit Expansion

    Funding Sources â BIA

    Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are expanding coverage for the diagnosis and treatment of autism spectrum disorders.

    The coverage became effective Oct. 15, 2012.

    BCBSM and BCN coverage for autism spectrum disorder will include benefits for:

    • Applied behavior analysis, a specialized treatment for autism
    • Physical therapy/speech therapy/occupational therapy as part of ASD treatment
    • Nutritional counseling as part of ASD treatment
    • Other mental health benefits to diagnose and treat autism
    • Other medical services used to diagnose and treat autism

    Theres been a change in the services that apply toward the $50,000 annual benefit limit for autism services. Physical therapy, occupational therapy, speech therapy and nutritional counseling wont be applied to the annual benefit limit. The Blues will continue to apply a limit of $50,000 per year for applied behavior analysis services through age 18.

    Services beyond the age or dollar limit will be reviewed for medical appropriateness and may be covered if medically necessary.

    NOTE: Benefits at a Glance charts obtained through the quoting tools that include ASD benefits effective Oct. 15, 2012, dont currently reflect the proper information regarding whats included in the $50,000 annual maximum. Well keep you informed as further details emerge.

    Heres what must occur for applied behavior analysis treatment to be payable:

    Autism providers

    Out-of-state residents

    ASC opt-in process

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    Important: Requirements For Coverage

    Your benefit booklet may include more information on these services, including prior review and certification requirements.

  • ABT must be provided or supervised by one of the following licensed professionals who is also certified to provide this treatment:
  • Licensed psychologist or psychological associate
  • Licensed psychiatrist or developmental pediatrician
  • Licensed speech and language pathologist
  • Licensed occupational therapist
  • Licensed clinical mental health counselor
  • Licensed marriage and family therapist
  • Board-certified behavior analyst
  • You can search the above provider types on our Provider Directory. It may be necessary to contact the ones in your network to confirm if they offer ABT services.

  • Please read our Medical Policy on ABT, which shows all necessary criteria to be met, including provider qualifications. This Policy can be used in talks with a provider to help determine if services may be covered.

  • Below, you will find links to providers who have indicated they may offer some ABT services. You will still need to meet the Medical Policy criteria through the authorization process for these services to be covered.
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