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Does Blue Cross Blue Shield Cover ABA Therapy?

Does Blue Cross Blue Shield Cover ABA Therapy?

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Does Blue Cross Blue Shield Insurance Cover ABA Therapy?

Yes, Blue Cross Blue Shield insurance may cover the cost of Applied Behavior Analysis (ABA) therapy. Depending on the details of your particular coverage plan, some services can be fully or partially covered.

ABA therapy is founded on the science of learning and behavior. Typically, it is used for autism treatment and other developmental disabilities. It teaches actions that will make patients’ lives safer and more satisfying.1 ABA therapy is an evidence based therapy that focuses on a behavioral approach. It can also be used for in-home autism therapy.

Licensed therapists help autistic individuals develop abilities such as:

  • Language and communication skills
  • Social skills
  • Hygiene and self-care practices
  • Leisure and play abilities
  • Motor skills

How to Verify BCBS ABA Therapy Insurance Coverage

Athena Care is in-network with most major insurance plans, providing behavioral health care throughout Tennessee. Filling out our free and confidential online insurance verification form is the best method to determine your Blue Cross Blue Shield ABA therapy coverage.

Allow our highly qualified care coordinators to contact your insurance company for more information about your Blue Cross Blue Shield ABA therapy benefits. A care coordinator will review your plan and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared and discussed remains confidential.

Insurance may be able to help cover the cost of therapy. Find out if your insurance provider can help with the costs by filling in our confidential insurance verification form below.

Requirements, Eligibility & Process for Blue Cross Blue Shield ABA Coverage

According to Tennessee state law, contracts and plans that offer benefits for neurological illnesses must also provide autism benefits for treating children under the age of 12.2

For those under 18, most Blue Cross Blue Shield insurance policies pay the costs of therapies that treat autism.3

ABA therapy Blue Cross Blue Shield coverage begins with a request from a Blue Cross Blue Shield ABA therapist provider. The first step in the pre-authorization process for insurance coverage will be to confirm whether:

  • The supplier offering ABA therapy is a certified behavior analyst.
  • The member has Blue cross Blue Shield ABA therapy coverage.
  • The initial treatment strategy complies with the child’s medical requirements.
  • A licensed diagnostician has given the member an autism diagnosis.  

How Much Does ABA Therapy Cost Without Insurance?

The average cost of Applied Behavior Analysis (ABA) is $120 per hour, and a 30 risperidone, 1 mg oral tablets supply, is about $18. Some children require up to 40 hours of ABA therapy each week to reach their full potential, which costs $4,800 per week or $249,600 per year.4

Forbes estimates that the annual cost of ABA therapy without insurance is about $17,000.

It might range from $45,000 to $100,000 annually for some children.5

The CDC estimates that average annual medical costs for a child with one of the autism spectrum disorders are $4,110 to $6,200 higher than for children without the condition.6

Sources

  1. “Questions and Answers About ABA.” Autism Speaks, 11 Aug. 2021, www.autismspeaks.org/blog/questions-and-answers-about-aba.
  2. “Autism and Insurance Coverage State Laws.” National Conference of State Legislatures, 24 Aug. 2021, www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.
  3. Behavioral Health | BlueCare Tennessee. bluecare.bcbst.com/get-care/behavioral-health.
  4. Tatom, Carol RBT. Autism Parenting Magazine, 2022, “How Much Does ABA Therapy for Autism Cost?” https://www.autismparentingmagazine.com/aba-therapy-autism-cost/
  5. Molko, Ronit. “What Is Covered? The Insurance Landscape for Autism Services.” Forbes, 18 Apr. 2019, www.forbes.com/sites/forbesbooksauthors/2019/04/18/what-is-covered-the-insurance-landscape-for-autism-services/?sh=133bbd3325c2.
  6. “Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC.” Centers for Disease Control and Prevention, 31 Mar. 2022, www.cdc.gov/ncbddd/autism/facts.html.

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155