Healthy Blue provides insurance coverage for Applied Behavior Analysis (ABA) therapy, which is a treatment often used for individuals with autism spectrum disorder (ASD). Understanding the specifics of this coverage can help families access necessary services.

Key Features of Coverage

• Eligibility: Coverage is typically available for children diagnosed with autism or related disorders.

• Types of Services Covered: This may include direct therapy, assessments, and consultations with licensed behavior analysts.

• Provider Network: Services must generally be provided by in-network providers to ensure full coverage.

• Limitations: There may be limits on the number of therapy hours covered per week or per year.

• Prior Authorization: Some services may require prior authorization from Healthy Blue before they are covered.

How to Access ABA Therapy Services

1. Obtain a Diagnosis: Ensure that the individual has a formal diagnosis of autism or a related condition.

2. Find a Provider: Locate an in-network ABA therapy provider through the Healthy Blue provider directory.

3. Request Authorization: If required, submit a request for prior authorization for the therapy services.

4. Schedule Therapy: Once authorized, schedule therapy sessions with the provider.

Important Considerations

• Documentation: Keep thorough records of all therapy sessions and communications with providers.

• Review Policy Details: Familiarize yourself with the specific terms and conditions of your Healthy Blue plan regarding ABA therapy.

• Appeals Process: If coverage is denied, understand the appeals process to challenge the decision.