ABA therapy and Blue Cross Blue Shield

What is usually covered

Blue Cross Blue Shield plans generally cover ABA for an autism diagnosis when it is medically necessary and prior authorized. The specifics depend far more on your individual plan document than on the insurer's name on the card.

Self-funded or fully insured?

Ask your employer or plan administrator whether your plan is self-funded or fully insured. Fully insured plans follow your state's autism mandate. Self-funded plans follow federal ERISA rules and are not bound by it. Many self-funded plans cover ABA anyway, but that single answer tells you which rulebook applies to you.

Before your first session

• Confirm the provider is in network, not merely willing to bill your plan.
• Ask what your authorization covers: how many hours, over what date range.
• Ask what your copay per session is, and whether the deductible applies.
• Get the reauthorization date in writing and diarise it a month early.

Finding agencies

Where an agency has not published its accepted plans, open your county page and call to ask.