ABA therapy and Anthem

What is covered

Anthem generally covers ABA for an autism diagnosis when it is medically necessary and prior authorized. Your plan document decides the specifics.

Anthem is a Blue Cross Blue Shield licensee operating in a number of states. Because it is a Blue plan, the rules that apply are the ones set by the Anthem plan in your state.

Ask them: Which state's Anthem plan am I on, and who administers the behavioral benefit?

Self-funded or fully insured?

Ask your employer which yours is. Fully insured plans follow your state's autism mandate; self-funded plans follow federal rules instead. Many cover ABA either way.

Before your first session

• Confirm the agency is in network, not just willing to bill.
• Ask how many authorized hours, over what dates.
• Ask your copay per session.
• Get the reauthorization date in writing.