BCBS Basic FEP Coverage for ABA???

[Anonymous]

I'm currently trying to navigate the process to at least get my dd an assessment for ABA. She is dx with autism. We have BCBS FEP Basic.

So the ABA company supposedly got my insurance verification and it says this
'. We were quoted that ABA is a covered benefit on your plan. Your immediate out of pocket expenses/ deductible are listed as $5500. After the deductible has been met, your insurance kicks in and will cover 80% of services. Your plan has a $5500 individual out of pocket maximum regarding home and center based ABA services. This means that once your out of pocket costs accrue to $5500, ABA will be covered at 100% for the remainder of your insurance plan year. Your plan requires authorization for ABA services, which our insurance team is currently working on. "

Does this sound...right? I'm stuck at the $5500 OOP and the 80%. Usually with Basic, we just pay a co pay.

I will call BCBS but it will be a few days before I can.

[Anonymous]

It could be. Here is your plan information: https://www.fepblue.org/benefit-plans

[Anonymous]

I think that mean she they pay 80% until you reach $5500 in your costs. After that, they pay 100% of allowable claims.

[Anonymous]

Is the ABA company in-network for BCBS? Basic doesn’t cover any services for out of network providers. There may be a weird loophole for ABA if there are no in network providers and that’s why they’re quoting the high deductible. Most therapists are not in-network. You may be better switching to BCBS standard.

[Anonymous]

We had BCBS Basic when my son did ABA in fall-winter of 2018-2019. We used SPARKS, which is in-network, and had a $40 copay for each visit.

BCBS initially said there was no co-pay, so the bills came as a bit of a surprise, but still better than paying out of pocket! ABA was not useful for my son, so we didn't continue after a few months. Good luck!

[Anonymous]

Anonymous wrote:We had BCBS Basic when my son did ABA in fall-winter of 2018-2019. We used SPARKS, which is in-network, and had a $40 copay for each visit.

BCBS initially said there was no co-pay, so the bills came as a bit of a surprise, but still better than paying out of pocket! ABA was not useful for my son, so we didn't continue after a few months. Good luck!

This is what I was expecting to hear from the ABA place-usually we just pay a co pay, not the percentage stuff. I am calling BCBS tomorrow and the ABA place too.

[Anonymous]

OP here-made calls and my coverage is $30 co-pay per day, no limit.