Insurance Coverage Guide

Does Anthem Cover ABA Therapy?

Anthem is one of the largest health benefits companies in the United States, serving over 45 million members. As a Blue Cross Blue Shield licensee in many states, Anthem provides comprehensive autism and ABA therapy coverage with a strong network of behavioral health providers.

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Anthem ABA Therapy Coverage Details

Anthem covers ABA therapy as part of its behavioral health benefits. Coverage includes functional behavior assessments, treatment planning, intensive behavioral intervention, and caregiver training. Anthem typically approves 20-40 hours per week based on the child's treatment plan and medical necessity.

Typical Copay

$20-$50 per session

Per session (varies by plan)

Prior Authorization

Required

We help with the auth process

Network Type

PPO, HMO, EPO plans

Plan options available

Anthem ABA Coverage by State

Anthem provides ABA therapy coverage in these states where Harmony Care Finder operates:

IN · VA · GA · CO · MO

Frequently Asked Questions: Anthem & ABA Therapy

Does Anthem cover ABA therapy?

Anthem covers ABA therapy as part of its behavioral health benefits. Coverage includes functional behavior assessments, treatment planning, intensive behavioral intervention, and caregiver training. Anthem typically approves 20-40 hours per week based on the child's treatment plan and medical necessity.

What is the typical copay for ABA therapy with Anthem?

The typical copay for ABA therapy with Anthem is $20-$50 per session. Actual costs depend on your specific plan, deductible status, and whether you use in-network providers. Many families pay little to nothing out-of-pocket for ABA services.

Does Anthem require prior authorization for ABA therapy?

Yes, Anthem typically requires prior authorization for ABA therapy services. This means your provider needs to submit a treatment plan and get approval before starting services. Harmony Care Finder helps families navigate this process and connects you with providers experienced in Anthem authorizations.

How do I find an ABA provider that accepts Anthem?

Harmony Care Finder verifies insurance acceptance before matching you with providers. Simply tell us your Anthem plan details, and we'll connect you with verified providers in your area who accept your specific plan. Our service is free for families.

How many hours of ABA therapy does Anthem cover?

Coverage hours depend on medical necessity as determined by the treating BCBA's assessment. Most Anthem plans cover 20-40 hours per week of ABA therapy when clinically recommended. Hours are typically reviewed every 6 months during reauthorization.

Other Insurance Providers

Learn about ABA therapy coverage from other major insurance providers:

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