Does Blue Cross & Blue Shield of Mississippi cover ABA therapy?

The short answer

Many Blue Cross & Blue Shield of Mississippi plans cover ABA therapy for autism, but coverage depends on your specific plan. The only way to know for sure is to check your child's benefits, and that's something our team helps with.

Mississippi's autism insurance law

In 2015, Mississippi passed a law requiring certain health plans to cover the screening, diagnosis, and treatment of autism, including ABA therapy. It's found at Mississippi Code § 83-9-26. According to the Mississippi Insurance Department, the law applies to:

• All large group health plans
• Older (“grandfathered”) plans sold in the individual and small group markets

It doesn't apply to:

• Newer individual and small group plans
• Many self-funded employer plans, which federal law exempts from state insurance rules
• Medicare supplement and other limited-benefit policies

Under the law, plans don't have to cover ABA past age 8, and the ABA benefit is limited to 25 hours a week, though coverage can go beyond those limits when an ongoing treatment plan shows it's medically necessary. The Insurance Department lists Blue Cross & Blue Shield of Mississippi among the insurers that voluntarily removed the age restriction for ABA.

If you get insurance through work, ask your HR department whether your plan is fully insured or self-funded. It makes a difference.

What BCBS of Mississippi requires before ABA starts

In its response to the Mississippi Insurance Department, Blue Cross & Blue Shield of Mississippi described these steps:

1. Approval for the assessment. Prior authorization is required for the initial autism assessment.
2. An order and a treatment plan. ABA needs an order from an in-network physician or licensed psychologist, plus an individualized treatment plan with measurable goals.
3. Approval for therapy. ABA is approved for six months at a time, based on the approved treatment plan.
4. Reassessment. At six months, your child is reassessed and an updated plan is submitted.

That response dates from 2018, and insurers update their rules, so we confirm the current requirements for each child.

What you'll pay

Your share depends on your plan's deductible, copay, and coinsurance, and on whether the provider is in network. Ask for those numbers before services begin, and ask whether there are limits on hours or visits.

Questions to ask BCBS

• Does my plan cover ABA therapy for autism?
• Is prior authorization needed for the assessment and for therapy?
• What are my deductible, copay, and coinsurance for ABA?
• Are there limits on hours, visits, or age?
• Is Wild & Free Behavior in network for my plan?

The member services number is on the back of your card. Write down who you spoke with and the date.

If something is denied

Ask for the reason in writing and what would be needed to reconsider. The Mississippi Insurance Department's autism hotline, 1-833-488-6472, can also help you understand your options. It's open weekdays from 8 a.m. to 5 p.m. Central.

How we help

We work with Blue Cross & Blue Shield of Mississippi. Our team checks your child's benefits and helps with the approval requests for the assessment and the treatment plan. If BCBS isn't your insurance, we'll talk through other options, including private pay.

Insurance and private pay at Wild & Free Behavior, or call 662-539-7129.