ABA therapy and Blue Cross Blue Shield

What is covered

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

Blue Cross Blue Shield is not one company. It is an association of independent local plans, so ABA coverage, prior authorization and network rules genuinely differ from one state's Blue plan to the next, even with the same logo on the card.

Ask them: Which Blue plan issued my card, and what are that plan's ABA rules?

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.