Support for families living with autism
The Autism Program is dedicated to getting you and your family the support and treatment you need.
The Autism Program
There is currently no cure for autism spectrum disorder (ASD) but research shows that early intervention treatment services can greatly improve a child’s development. Early diagnosis and intervention can also reduce the cost of lifelong care by two-thirds.
This guide will help you understand and navigate the benefits and resources available to you and your child.
Blue Cross assistance
A Blue Cross and Blue Shield of Minnesota (Blue Cross) Board-Certified Behavioral Analyst (BCBA) case manager will help you find an in-network provider who meets your child’s needs. If an in-network provider is not available in your area, the case manager will assist in navigating other options to get your child the help needed.
Your Blue Cross case manager is available to assist you throughout the course of your child’s treatment. This may include contacting you and your provider for updates and to identify any new needs.
How case managers can help:
- Provide clinical guidance and caregiver support
- Ensure access to high quality, evidence-based applied behavior analysis (ABA) services
- Help find available in-network providers
- Coordinate with providers and care systems
- Review treatment plans
- Interpret medical policies and treatment requirements
- Screen for and assess additional family needs
- Serve as ongoing resource as your child grows
Important: Before beginning any treatment, make sure the health care provider is covered by your medical plan. This will help keep your out-of-pocket costs down.
Call us to get started
Call the number on the back of your member ID card and ask to speak with a behavioral health case manager.
Autism resources
The following websites offer a wealth of resources about autism, including articles, research and other free materials.
Treatment options
Treatment for autism may include Applied behavior analysis (ABA) therapy, which involves special behavioral training that rewards good behavior. By using positive reinforcement, children can be taught communication, self-help and social skills and how to help themselves as they grow older.
Specialized treatment may also include programs like speech, occupational and physical therapies. These therapies are important components of managing ASD and may be included in the child's treatment program. The exact treatment your child will need depends on their unique symptoms and may change over time.
Coverage for these treatments falls within two categories: mental health services and medical services. The services described here are typical for autism but will vary from child to child.
Be sure to call Blue Cross to verify medical or mental health benefits and coverage before beginning a new service or working with a new provider.
Medical services
- Speech therapy develops language and social skills for more effective communication.
- Occupational and physical therapies focus on coordination and motor skills. Occupational therapy can also help your child develop methods to process sensory information (sight, sound, touch and smell) in more manageable ways.
Mental health services
- Applied behavior analysis (ABA), early intensive behavioral intervention (EIBI)-commercial plans, and early intensive developmental and behavioral intervention (EIDBI)-Minnesota Health Care programs are terms often used interchangeably. The range of services under ABA, EIBI, and EIDBI all fall within the same benefit category.
How does treatment work
1. Needs assessment
This happens at your initial appointment with the program manager, who is a licensed professional (M.D. or Ph.D.) or a board-certified behavior analyst. They will conduct a thorough evaluation to identify symptoms specific to your child and determine the most appropriate and effective treatment.
2. Treatment plan
Based on the assessment, the program manager will work with you to develop a detailed treatment plan. This includes methods for addressing specific symptoms as well as how often treatments occur and what type of setting.
3. Treatment sessions
The therapy assistant, also known as a behavioral technician, is trained in ABA therapy but may not be licensed or certified. These assistants perform tasks described in the treatment plan and they document outcomes. They regularly consult with the program manager to discuss the child’s treatment plan progress.
4. Progress reports
Your program manager will measure progress and, based on your child’s response to treatment, recommend different programs if necessary.
ABA overview
ABA, when implemented at an early age, can help children develop important milestones pertinent to learning, such as basic skills like looking, listening and imitating.
- ABA therapy is implemented by a one-to-one therapist to teach, prompt and shape appropriate replacement behaviors using positive reinforcement, while modifying the environment to reduce challenging behaviors.
- ABA utilizes family/caregiver training to generalize skills to help children develop more complex skills such as reading and holding a conversation, as well as identifying basic emotions.
EIBI/EIDBI overview
EIBI/EIDBI uses multiple approaches and methods to treat young children, usually between the ages of 2 and 6.
- Group therapy works on developing social skills with peers. The sessions are usually held once a week for one to two hours.
- Individual therapy provides one-on-one treatment with a trained therapist. These sessions provide a safe, caring and confidential environment where children can explore feelings, beliefs or behaviors, work through challenging or influential memories and identify aspects of their lives that they would like to change or make better.
- Family therapy helps family members improve communication and resolve conflicts.
- Psychological testing assesses cognitive and emotional function using written, visual and verbal evaluations.
Frequently asked questions
To avoid paying higher out-of-pocket costs, it’s important to verify whether the provider is covered and how benefits would apply before your first visit. If they are not in your network you will pay more out of pocket. Contact your Blue Cross case manager or call the number on the back of your member ID card.
No. Some treatment may take place in a traditional clinic setting, but it could also take place in school or at home.
The best thing you can do to support your child is to learn as much as you can about the needs of a child with autism so you can effectively advocate for them. In addition, consider these ideas and opportunities:
- Participate in therapies so you can practice behavioral training at home.
- Get involved in the autism community. Joining a support group can provide not only emotional support but is an excellent resource to learn about services others have found helpful as well as other community resources.
- Recognize the accomplishments your child achieves, no matter the size. Focus on what they can do instead of comparing them to the development of other children.
- Keep balance in your home life. Spend quality time with your other children and spouse. Take care of yourself to make sure you get the rest you need to maintain your personal health and that of your family.
The amount you pay depends on the network status of the provider and your medical plan benefits. Call the number on the back of your member ID card to confirm your benefit coverage details.
Yes. Limits are based on medical necessity.
Call the number on the back of your member ID card or use our Find a Doctor tool. You must register and log in prior to searching for your provider.
Important coverage information
Step 1: Identify a qualified in-network provider
Your Blue Cross case manager can assist you. Or call the number on the back of your member ID card. Depending on your medical plan, if you use an out-of-network provider you may not have coverage and need to pay more for your care.
Step 2: Verify coverage
Your health care provider should always go online to our self-service provider portal or call Blue Cross Provider Service at 1-800-262-0820 to verify benefits, coverage and whether a prior authorization is needed. Prior authorization review takes approximately 10 business days.
Step 3: Claims process
After receiving care, your in-network provider will submit a claim to Blue Cross. If you use an out-of-network provider, you may have to submit the claim to Blue Cross.
Support resources
Case Management
Get help accomplishing your wellness goals or managing a health condition. Discover community resources as well as information that can help you succeed.
1-800-961-4758
Available for certain plans.
Doctor On Demand
24/7 online doctor
Meet face-to-face online with a board-certified doctor, psychiatrist or psychologist wherever you are with Doctor On Demand by Included Health.
Benefits vary by plan.
Learn to Live
Online behavioral health therapy
Living with stress, insomnia, depression, substance use or social anxiety? Learn to Live is an online program that's available anytime to help you work through it.
Visit learntolive.com/partners and use your code.
Available for certain plans.
Doctor On Demand® by Included Health is an independent company providing telehealth services.
Learn to Live, Inc. is an independent company offering online tools and programs for behavioral health support. Learn to Live is an educational program and should not be considered medical treatment.