Does Blue Cross Blue Shield Cover ABA Therapy in Nebraska?

Applied behavior analysis (ABA therapy) is widely regarded as the best treatment option for children with autism spectrum disorder (ASD). As such, it is commonly recommended for children with ASD, no matter where they fall on the autism spectrum.

That’s because ABA therapy is so flexible and customizable. It is catered to each individual child’s unique strengths and challenges, and is adjusted over time based upon their progress toward stated goals.

If your child has autism, you might be wondering whether Blue Cross Blue Shield covers ABA therapy in Nebraska. This is very important to many parents, as ABA therapy can be quite intensive and, as a result, a big financial commitment.

Here, we’ll discuss whether Blue Cross Blue Shield covers ABA therapy, and what you have to do in order to meet the requirements.

Learn more about insurance coverage for ABA Therapy
Learn more about Insurance coverage for ABA Therapy in Nebraska

Table Of Contents

Does Blue Cross Blue Shield Cover ABA Therapy in Nebraska?

In most cases, Blue Cross Blue Shield does cover ABA therapy in Nebraska. However, what coverage the company provides depends entirely on the specific insurance plan that you have.

Since 2015, Nebraska has mandated that insurance companies provide meaningful coverage for individuals with autism. This coverage includes diagnosis, pharmacy care, psychiatric care, psychological care, behavioral health treatments such as ABA therapy and therapeutic care such as speech or occupational therapy.

All individual grandfathered plans, fully insured large groups plans and fully insured small group grandfathered plans must adhere to Nebraska’s autism insurance law.

Individual non-grandfathered plans and fully insured small group non-grandfathered plans are not subject to this law. However, that doesn’t mean that any Blue Cross Blue Shield plans that fall under these categories don’t offer coverage.

This is why it’s important that you check with the company directly to figure out whether your plan covers ABA therapy.

What Coverage Does Blue Cross Blue Shield Provide?

Again, the exact coverage that Blue Cross Blue Shield provides for autism-related services can vary greatly from one plan to the next.

If the plan falls under the state-mandated list, then it must provide coverage for the services listed above. However, your child must be 21 years old or younger to qualify, and ABA therapy is limited to 25 hours per week.

Keep in mind that these are just minimum requirements. Your Blue Cross Blue Shield plan may offer additional coverages above and beyond these limits; they just can’t provide anything less than this if your plan is subject to the state’s autism insurance law.

What is Required for Your Child’s ABA Therapy to Be Covered by Insurance?

While the specific requirements may vary from plan to plan, generally speaking, your child must have an official diagnosis of ASD from a qualified healthcare provider. In most cases, this can be done by a developmental pediatrician, clinical psychologist or some other provider that Blue Cross Blue Shield approves.

Then, that provider must state that ABA therapy is a medically-necessary service for your child with ASD. From there, your insurance company will then likely just verify that your child is fully registered under your plan and that they meet the general coverage requirements.

Your Blue Cross Blue Shield plan may require pre-authorization before ABA therapy can begin. This usually involves choosing an ABA therapy provider from a pre-approved list as well as having your child’s treatment plan approved.

As long as you choose a provider from the pre-approved list, and an in-network medical professional states your child’s ABA therapy is medically necessary, then you shouldn’t have many issues getting the therapy approved.

Still, it’s very important that you work with an ABA therapy company that is reputable, trustworthy and has experience working with insurance companies. That will help to make the approval process easier for you, as they know how to streamline all aspects of it.

Blue Gems ABA Works with Blue Cross Blue Shield Plans in Nebraska

At Blue Gems ABA, we work with many different Blue Cross Blue Shield plans in Nebraska, helping families just like yours get their child’s ABA therapy treatment covered by insurance. We can help you meet the various requirements to get the treatment covered, and then provide your child with outstanding therapy that can help them grow.

We cater all of our treatment plans to each individual patient we see, which leads to the best outcomes possible.

To learn more, please contact us today. One of our local Nebraska locations is standing by:

• Omaha NE
• Omaha NE Clinic
• Lincoln NE
• Columbus NE Clinic

Nebraska ABA Coverage Breakdown by Insurance Plan Type