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Does Blue Cross Blue Shield Cover ABA Therapy in Missouri?

If a trained professional has diagnosed your child with autism spectrum disorder (ASD), they will likely recommend them to receive applied behavior analysis.

Also known as ABA therapy, it’s a science-based approach to learning that has been proven to help children on the autism spectrum improve their social, communication and daily life skills.

ABA therapy can also help patients modify certain behaviors that may be negative or harmful, which can lead to them living as independently as possible.

Parents have to plan for their child’s ABA therapy, as it is typically time-consuming. With some children being recommended for up to 40 hours per week, ABA therapy can also be expensive.

If you live in Missouri, though, you’re in luck, as the state mandates insurance coverage for many autism-related services. In this article, we’ll discuss whether Blue Cross Blue Shield covers ABA therapy in Missouri.

Key Takeaways

  • Missouri mandates insurance coverage for many autism-related services, including ABA therapy.
  • Blue Cross Blue Shield offers ABA coverage in Missouri, but benefits vary by plan.
  • An official autism diagnosis and a recommendation for ABA therapy are required for insurance approval.
  • Parents must confirm their specific plan’s details and obtain pre-authorization when needed.
  • Providers like Blue Gems ABA can help navigate insurance requirements and deliver therapy services.

Table Of Contents

Does Missouri Mandate Autism-Related Coverage?

As of 2011, Missouri mandates that most state-regulated insurance plans provide meaningful coverage for autism-related services. The state passed two bills in 2010 to enact that law, and then expanded it to cover those with developmental and physical disabilities in 2019 with SB 514.

Plans that are required to provide coverage under the law include fully insured large group plans, individual non-grandfathered plans and fully insured small group plans.

The state does have a somewhat unique aspect of its law that’s important to know.

Individual grandfathered plans are only required to provide a “mandated offering” of autism-related coverage. They aren’t required to provide coverage for autism-related treatment.

The services that are covered by Missouri’s law include an ASD diagnosis; psychiatric and psychological care; therapeutic care such as physical, occupational and speech therapy; pharmacy care; and rehabilitative or habitative care such as ABA therapy.

Missouri’s mandate is that insurance carriers cover any individual with ASD up to 19 years old. There is also an annual cap on coverage set at $40,000.

It’s also important to note that insurance carriers may decide to provide coverage above and beyond these mandates. They are just not allowed to provide coverage less than the state limits.

Coverage Factor Details in Missouri
State Coverage Mandate Missouri law requires most state-regulated insurance plans to cover autism-related services, including ABA therapy, for individuals up to age 19 with an annual cap of $40,000.
Blue Cross Blue Shield Coverage Most BCBS plans in Missouri cover ABA therapy. Coverage details vary by plan, so individual verification is necessary.
Plan Requirements A formal ASD diagnosis and a recommendation for ABA therapy, typically with a letter of medical necessity, are required for coverage.
Pre-Approval and Reassessments Pre-authorization may be required before starting ABA therapy. Periodic re-assessments may be needed for continued coverage.
Support from Providers Organizations like Blue Gems ABA assist families in navigating insurance and accessing ABA therapy with covered providers.

Does Blue Cross Blue Shield Cover ABA Therapy in Missouri?

Blue Cross Blue Shield does cover ABA therapy in Missouri under most plans.

However, the company is very large and offers a diverse selection of different insurance plans. As such, it’s vital for you to understand whether your specific plan provides coverage for ABA therapy and what that coverage is.

Some plans that Blue Cross Blue Shield offers will fully cover ABA therapy in Missouri, while others may offer limited coverage or none at all.

If you are unsure about the details of your specific plan, make sure to reach out to your insurance carrier directly.

What is Required to Have ABA Therapy Covered by Insurance?

Blue Cross Blue Shield has requirements in place that must be met in order for your child’s ABA therapy to be covered.

The first requirement is that your child must receive an ASD diagnosis from a trained professional. This could be a clinical psychiatrist or a developmental pediatrician, for example.

This provider must then formally recommend that your child gets ABA therapy to help them. Blue Cross Blue Shield will likely require the provider to write a letter of medical necessity to back up their recommendation.

Once this has been completed, you can search for ABA therapy providers that are in your network. You’ll then meet with the therapy team for an initial evaluation, and they will craft a personalized treatment plan for your child.

Blue Cross Blue Shield may need to review this treatment plan first to give their pre-approval so that the services will be covered. They also may need to review re-assessments from time to time to approve continuing ABA therapy services.

Blue Gems ABA Works with Most Insurance Plans in Missouri

Parents of children with autism in Missouri will be happy to know that the state mandates insurance coverage for most autism-related services. This includes Blue Cross Blue Shield, though you should check your specific plan to ensure it provides this coverage, and at what levels.

At Blue Gems ABA, we work with most insurance plans in Missouri to help your child with ASD get the ABA therapy treatment they need at an affordable cost. Our team is experienced in working directly with insurance carriers, and can help you navigate the process.

To learn more, please contact us today.

FAQs

  • Q: Does Missouri law require insurance to cover ABA therapy?
    A: Yes, for most state-regulated plans, Missouri law mandates ABA therapy coverage up to age 19 with a $40,000 annual cap.
  • Q: Does Blue Cross Blue Shield cover ABA therapy in Missouri?
    A: Yes, most BCBS plans provide ABA therapy coverage, though plan details vary.
  • Q: What do I need to get ABA therapy approved?
    A: A diagnosis of ASD, a recommendation for ABA therapy, and a letter of medical necessity from a licensed professional.
  • Q: Is pre-authorization required for ABA therapy?
    A: Often, yes. BCBS may require pre-approval of the treatment plan and ongoing reassessments.
  • Q: Can Blue Gems ABA help with insurance navigation?
    A: Absolutely. They work with most Missouri insurance providers and assist families with approvals and treatment setup.