What Do I Need to Know About Autism Coverage?

Most Blue Cross Blue Shield of Michigan health 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.

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

Find your plan's 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 What’s Covered. Look for autism. In that section you’ll 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 What’s 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

Don’t 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 we’ll help.

Getting services

Plans can vary when it comes to what they require before getting autism services. To help make sure your plan will cover or help pay for treatment, there are certain things you should check.

The diagnosis of autism spectrum disorder must be validated by a documented comprehensive assessment demonstrating the presence of diagnostic criteria based on the DSM-5-TR. The comprehensive assessment must be completed by a licensed physician, psychologist, and/or other licensed clinicians qualified to diagnose autism by state licensure and related training.

For applied behavior analysis

There are two ways you can obtain a comprehensive evaluation:

  • Through an approved autism evaluation center (AAEC) in Michigan. The center will arrange for the member to be evaluated by each discipline and will give the member the results of the evaluation. Members would then be able to provide this diagnostic evaluation to an autism treatment provider who will then obtain an authorization for treatment from Blue Cross Behavioral Health.

  • By working with a primary care provider and/or independent autism evaluation provider(s)* members will obtain a comprehensive evaluation. Members would then be able to provide this diagnostic evaluation to an autism treatment provider who will then obtain an authorization for treatment from Blue Cross Behavioral Health.

    You can find an autism treatment provider on the list of Approved Autism Evaluation Centers (PDF)

    *Independent autism evaluation providers may include: pediatrician, developmental pediatrician, pediatric neurologist, neurologist, child psychologist, child psychiatrist ,adult psychiatrist, neuropsychologist, psychologist, Speech and language therapist. 

If you have concerns about getting a diagnosis from an AAEC or independent autism evaluation providers, contact one of the following based on your coverage.

Who can provide ABA?

  • In most cases, the provider must be a Licensed Behavior Analyst, or LBA, or a fully licensed psychologist. Find a doctor.

Is preauthorization from your plan required before starting services?

  • All Blue Care Network HMO plans require preauthorization
  • Some Blue Cross Blue Shield of Michigan PPO plans require preauthorization, but not all; be sure to check your autism coverage

When preauthorization is required, the analyst or psychologist usually contacts us to get it.

For all other services, including physical, speech and occupational therapy and nutritional counseling

Before getting services, you should ask:

  • Is an autism spectrum disorder diagnosis required?
  • Does your plan require preauthorization?
  • Will your plan help pay for a therapist who doesn’t take Blue Cross?

If you have questions about any plan requirements or need help:

  • Members who get insurance through an employer: Talk to your HR department or whoever handles your benefits
  • Or, call the mental health preauthorization number on the back of your Blue Cross ID card; it may be called something different, like behavioral or mental health

For applied behavior analysis

There are two ways you can obtain a comprehensive evaluation:

  • Through an approved autism evaluation center (AAEC) in Michigan. The center will arrange for the member to be evaluated by each discipline and will give the member the results of the evaluation. Members would then be able to provide this diagnostic evaluation to an autism treatment provider who will then obtain an authorization for treatment from Blue Cross Behavioral Health.

  • By working with a primary care provider and/or independent autism evaluation provider(s)* members will obtain a comprehensive evaluation. Members would then be able to provide this diagnostic evaluation to an autism treatment provider who will then obtain an authorization for treatment from Blue Cross Behavioral Health.

    You can find an autism treatment provider on the list of Approved Autism Evaluation Centers (PDF)

    *Independent autism evaluation providers may include: pediatrician, developmental pediatrician, pediatric neurologist, neurologist, child psychologist, child psychiatrist ,adult psychiatrist, neuropsychologist, psychologist, Speech and language therapist. 

If you have concerns about getting a diagnosis from an AAEC or independent autism evaluation providers, contact one of the following based on your coverage.

Who can provide ABA?

  • In most cases, the provider must be a Licensed Behavior Analyst, or LBA, or a fully licensed psychologist. Find a doctor.

Is preauthorization from your plan required before starting services?

  • All Blue Care Network HMO plans require preauthorization
  • Some Blue Cross Blue Shield of Michigan PPO plans require preauthorization, but not all; be sure to check your autism coverage

When preauthorization is required, the analyst or psychologist usually contacts us to get it.

For all other services, including physical, speech and occupational therapy and nutritional counseling

Before getting services, you should ask:

  • Is an autism spectrum disorder diagnosis required?
  • Does your plan require preauthorization?
  • Will your plan help pay for a therapist who doesn’t take Blue Cross?

If you have questions about any plan requirements or need help:

  • Members who get insurance through an employer: Talk to your HR department or whoever handles your benefits
  • Or, call the mental health preauthorization number on the back of your Blue Cross ID card; it may be called something different, like behavioral or mental health
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