Blue Cross Blue Shield Autism Testing & Treatment Coverage in TN

Does Blue Cross Blue Shield Cover Autism Testing & Treatment?

Yes, Blue Cross Blue Shield (BCBS) of Tennessee health insurance covers Autism testing and treatment under Tenn. Code Ann. § 56-7-2367.¹ Autism spectrum disorder is classified as a neurological illness under the legislation. Contracts and insurance that provide benefits for neurological illnesses must include benefits and coverage for autism therapy for children under 12.

Jump to Section

• Does Blue Cross Blue Shield Cover Autism Testing & Treatment?
• How to Verify BCBS Autism Coverage
• What is Autism?
• Does Blue Cross Blue Shield Cover Autism Testing?
• Does Blue Cross Blue Shield Cover Autism Treatments & Medications?
• How To Find BCBS Autism Testing & Treatment Clinics Near Me?
• How Much Does Autism Testing & Treatment Cost Without Insurance?

How to Verify BCBS Autism Coverage

Athena Care is in-network with most major insurance plans. Find out more about your insurance coverage by calling your insurance company or contacting Athena Care at 877-641-1155.

What is Autism?

Autism Spectrum Disorder (ASD) is a developmental disease that can lead to significant social, communicative, and behavioral difficulties. People with Autism can have a wide range of cognitive, reasoning, and problem-solving abilities and disabilities, ranging from gifted to severely impaired.²

Types of Autism

There are five types of Autism:³

• Asperger’s Syndrome
• Rett Syndrome
• Childhood Disintegrative Disorder (CDD)
• Kanner’s Syndrome
• Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

Signs & Symptoms of Autism

Although there is typically nothing about people with Autism that distinguishes them from others in terms of appearance, they may communicate, engage, conduct, and learn in unique ways. The signs of Autism Spectrum Disorder include, but are not limited to the following:⁴

• Difficulty developing social communication and interpersonal skills
  • Example – Does not respond to name by nine months of age
• Restricted or repetitive interests or behaviors
  • Example – Becomes upset by minor changes in routine
• Delayed cognitive, learning, language, and movement skills
• Hyperactive, impulsive, and/or inattentive
• Epilepsy or seizures
• Unusual sleeping and eating patterns
• Gastrointestinal issues (i.e., constipation)
• Mood swings or emotional reactions that are out of the ordinary
• Anxiety, tension, or excessive worry
• Fearlessness or greater than expected fear

Does Blue Cross Blue Shield Cover Autism Testing?

Blue Cross Blue Shield Autism assessments may be covered depending on your specific insurance plan’s benefits.

Because there is no medical test for Autism Spectrum Disorder (ASD), such as a blood test, diagnosing the illness can be difficult. To diagnose, doctors look at the child’s developmental history and behavior.

Developmental monitoring examines how your child develops and evolves and whether they fulfill developmental milestones in areas such as playing, learning, speaking, acting, and moving. Parents, grandparents, early childhood providers, and other caregivers can conduct developmental monitoring.

Developmental screening examines your child’s development in greater detail. A quick test will be given to your child, or you will be asked to fill out a questionnaire about your child. A doctor or nurse and other experts in the healthcare, community, or educational sectors can perform developmental screening.

Autism can be discovered as early as 18 months of age. Therefore, a diagnosis by an experienced professional by the age of two can be considered reliable. Many, however, do not obtain a definitive diagnosis until they are considerably older.⁵

Does Blue Cross Blue Shield Cover Autism Treatments & Medications?

Yes, Blue Cross Blue Shield may cover Autism treatments and medications. Your plan’s benefits will determine your eligibility and the details of your Blue Cross Blue Shield Autism coverage.

There is currently no medication specifically for Autism or that can treat all of its symptoms. However, some drugs can aid in treating Autism symptoms, particularly certain behaviors.

According to research, medication is most effective when combined with evidence-based psychotherapy, like Applied Behavioral Analysis (ABA). ABA treatment applies what we know about behavior to real-life settings. The goal is to encourage positive behaviors while reducing detrimental or learning-inhibiting behaviors. This type of therapy can help improve language and communication skills, attention, focus, social skills, memory, and academics.⁶

Some antipsychotic medications, such as Risperidone and Aripiprazole, have been approved by the FDA for treating irritability associated with Autism in children of certain ages.⁷

How To Find BCBS Autism Testing & Treatment Clinics Near Me?

With Athena Care, gaining access to Autism testing clinics in Tennessee has never been easier. A care coordinator can assist you with any questions or concerns about Blue Cross Blue Shield Autism coverage at one of various Tennessee locations. Athena Care health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m.

When choosing Autism doctors or care providers, it’s important to keep the following in mind:

• Education, training, license, and years of experience
• Specialties and services offered
• Treatment methods and philosophies
• Insurance companies they work with
• Office hours
• Pricing
• Session length

Also, don’t be afraid to ask questions.

Here, you’ll find a list of practitioners organized by city and information about their backgrounds and specialties.

How Much Does Autism Testing & Treatment Cost Without Insurance?

The following are average costs, though they may vary by location and other variables and may not reflect the actual cost of what you’ll pay for testing or treatment.

Doctor’s visits alone can range from a few hundred dollars to more than $2,700. In the United States, the typical cost of psychotherapy ranges from $100 to $200[i] a session, dependent upon the state and the length of the session.

The cost of a supply of 30 count Risperidone 1 mg oral tablets is roughly $18,⁹ and the average price of ABA is $120 an hour. Some children require up to 40 hours of ABA therapy every week to reach their full potential, which amounts to $4,800 per week or $249,600 per year.⁹

Sources

1. “Autism and Insurance Coverage State Laws.” NCSL, 2021, https://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx
2. “What is Autism Spectrum Disorder?” U.S. Department of Health & Human Services, 2020, https://www.cdc.gov/ncbddd/autism/facts.html
3. “What Are the 5 Types of Autism?” Integrity, Inc., 2021, https://www.integrityinc.org/what-are-the-5-types-of-autism/
4. “Signs and Symptoms of Autism Spectrum Disorders.” U.S. Department of Health & Human Services, 2021, https://www.cdc.gov/ncbddd/autism/signs.html
5. “Screening and Diagnosis of Autism Spectrum Disorder.” U.S. Department of Health & Human Services, 2020,  https://www.cdc.gov/ncbddd/autism/screening.html
6. “Applied Behavior Analysis.” Autism Speaks Inc., 2022, https://www.autismspeaks.org/applied-behavior-analysis
7. “Medication Treatment for Autism.” NIH, 2021, https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment
8. “Risperidone Prices, Coupons and Patient Assistance Programs.” IBM Watson Micromedex, Cerner Multum™, ASHP, 2022, https://www.drugs.com/price-guide/risperidone
9. Tatom, Carol RBT. Autism Parenting Magazine, 2022, “How Much Does ABA Therapy for Autism Cost?” https://www.autismparentingmagazine.com/aba-therapy-autism-cost/