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 treatment benefits include:
Your health 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.
The easiest way is to log in to your member account. You can do that using our website or the Blue Cross Blue Shield of Michigan 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:
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:
Don’t see autism listed or have questions about autism coverage?
Health plans can vary when it comes to what they require before getting services for autism care. 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 for an autism diagnosis must be completed by a licensed physician, psychologist, and/or other licensed clinicians qualified to diagnose autism by state licensure and related training.
There are two ways you can obtain a comprehensive evaluation:
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?
Is prior authorization from your plan required before starting services?
When prior authorization is required, the analyst or psychologist usually contacts us to get it.
Before getting services, you should ask:
If you have questions about any plan requirements or need help:
How to obtain a comprehensive evaluation:
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.
Have questions? Call the mental health prior authorization number on the back of your Blue Cross ID card; it may be called something different, like behavioral or mental health.
*Independent autism evaluation providers may include: pediatrician, developmental pediatrician, pediatric neurologist, neurologist, child psychologist, child psychiatrist ,adult psychiatrist, neuropsychologist, psychologist, Speech and language therapist.
There are two ways you can obtain a comprehensive evaluation:
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?
Is prior authorization from your plan required before starting services?
When prior authorization is required, the analyst or psychologist usually contacts us to get it.
Before getting services, you should ask:
If you have questions about any plan requirements or need help:
How to obtain a comprehensive evaluation:
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.
Have questions? Call the mental health prior authorization number on the back of your Blue Cross ID card; it may be called something different, like behavioral or mental health.
*Independent autism evaluation providers may include: pediatrician, developmental pediatrician, pediatric neurologist, neurologist, child psychologist, child psychiatrist ,adult psychiatrist, neuropsychologist, psychologist, Speech and language therapist.