Father and son hugging each other at home

Blue Cross Removes Age Limits from Autism Treatment Services

Medically necessary autism treatment services will now be covered for members by Blue Cross Blue Shield of Michigan with no age limit. 

Blue Cross is retroactively updating its medical policy, effective Jan. 1, 2022, to allow members to continue to receive medically necessary autism spectrum disorder services after age 19. Previously, members aged out of coverage for certain services when they turned 19 – a policy that followed state of Michigan legal guidelines.  

These age limits are no longer considered an appropriate way to determine whether treatment for autism spectrum disorder is medically necessary. This Blue Cross policy change is in line with guidance from the Michigan Department of Insurance and Financial Services and the federal government.  

Members who turn 19 in 2022 and would have previously aged out of autism spectrum disorder services will now remain eligible to continue medically necessary treatment.  

Autism spectrum disorder manifests itself in a wide variety of behaviors based on symptom type and severity. This spectrum disorder includes verbal and nonverbal challenges and has links to a group of complex neurodevelopmental conditions. Autism can present itself differently in each person. While some individuals may exhibit notable speech delays and intellectual disabilities, others can experience barriers such as little to no language and/or have unusual interests and difficulty following social cues. It’s not uncommon for those on the spectrum to struggle in certain areas, while easily excelling in others.  

Most Blue Cross plans cover or help pay for services that treat autism spectrum disorders for members. Standard autism benefits include: 

  • Applied behavior analysis, or ABA 
  • Physical, speech and occupational therapy 
  • Nutritional counseling 

ABA is one behavioral treatment approach most commonly used with children with autism spectrum disorder. It involves a structured environment, predictable routines, and individualized treatment. Additional interventions complement ABA by including transition, aftercare planning and significant family involvement. ABA is designed to increase skills related to behavioral deficits, increase social skills and reduce behavioral excesses which can be barriers to learning. 

Check your coverage to see what services are covered through your plan by logging in to your member account on bcbsm.com or to the Blue Cross mobile app. Learn more about autism coverage offered by Blue Cross and Blue Care Network by visiting this page at bcbsm.com.  

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