Does Blue Cross Blue Shield Cover ABA in New York?

Yes. New York state law requires all commercial health insurance plans — including Blue Cross Blue Shield plans — to cover ABA therapy for children diagnosed with autism spectrum disorder. Here is what BCBS-insured NY families should know:

NY state law is on your side. The ABA coverage mandate means BCBS cannot deny coverage for ABA therapy on the basis that it is experimental or not medically necessary — it is a required benefit for children with an ASD diagnosis in New York.

Empire BlueCross BlueShield vs. Other BCBS Plans in NY

Important Distinction

Not All BCBS Plans in NY Are the Same

Empire BlueCross BlueShield is the BCBS affiliate responsible for individual and small group plans sold in New York state. However, if your employer is headquartered outside of New York, your employer-sponsored BCBS plan may be administered by a different BCBS affiliate — such as Anthem, Highmark, or another regional entity — with a different provider network.

Additionally, out-of-state BCBS plans that cover NY residents under BlueCard arrangements have different network structures from Empire's directly-contracted network. Always confirm which BCBS entity administers your specific plan before searching for in-network providers.

To confirm your plan type, check the back of your insurance card. The logo and plan name will typically indicate whether you have an Empire BlueCross plan, an Anthem plan, or a BlueCard product. If in doubt, call the member services number on your card.

The Prior Authorization Process for BCBS ABA

Whether you have Empire BlueCross BlueShield or another BCBS plan, the prior authorization process for ABA therapy in New York generally follows these stages:

  1. Initial diagnostic assessment. A licensed psychologist or BCBA conducts an evaluation to confirm the ASD diagnosis and establish a baseline. This may or may not require prior authorization depending on your specific plan.
  2. Treatment plan submission. Your BCBA develops a comprehensive treatment plan specifying goals, recommended hours, and setting. The provider submits this plan to BCBS for review.
  3. Ongoing session authorization. BCBS reviews and approves treatment in intervals — often every three to six months. The BCBA submits updated progress notes and plans at each interval.
  4. Annual reviews. Full treatment reviews are conducted annually to assess progress and adjust the treatment plan.

BCBS typically covers a range of ABA hours based on your child's clinical needs as documented by the BCBA — not a fixed number of hours. The treating BCBA's clinical judgment, backed by assessment data, drives the recommended intensity.

Why In-Network BCBS Providers Are Hard to Find

Challenge 1

Provider Directories Lag Behind Reality

BCBS provider directories are updated on a schedule, not in real time. A provider listed as in-network may have left the network, changed their services, or closed their caseload to new clients since the last directory update. Families who rely solely on the online directory often spend significant time calling providers who are not actually available.

Challenge 2

Many Listed Providers Have Waitlists

In-network status and availability are two different things. A provider can be fully credentialed with Empire BlueCross BlueShield and still have a waitlist of six months or longer. Knowing who is in-network is only the first step — knowing who has current openings is the harder part.

Challenge 3

Match Care ABA Has Current Knowledge

Because we work directly with ABA providers across New York, we maintain up-to-date knowledge of which providers are currently accepting BCBS-insured clients and which have open slots. This means we can skip past the providers with closed waitlists and connect your family with the ones who can actually serve you now.

How Match Care ABA Helps BCBS Families in NY

Benefit 1

Free Matching Service

Match Care ABA does not charge families for our matching service. We help you identify in-network BCBS providers with current availability at no cost to you. There is no commitment required to submit your information and see your options.

Benefit 2

Insurance-Confirmed Before We Refer

We confirm that a provider accepts your specific BCBS plan before making a referral. This eliminates the frustrating experience of contacting a provider only to learn they are not in-network with your plan or are not currently accepting new clients.

Benefit 3

Statewide NY Network

We serve BCBS families across all of New York — from the five boroughs to Long Island, Westchester, the Hudson Valley, and beyond. Whether you need home-based ABA, center-based ABA, or are open to either, we work to find the best available match for your family's situation.

Our Process

  1. Submit your information. Tell us your child's age, your location, your BCBS plan, your preferred therapy setting, and your timeline for starting services.
  2. We find your matches. We identify ABA providers currently in-network with your BCBS plan who have availability to accept a new client.
  3. Providers contact you directly. The matched providers reach out to your family — so you are not making cold calls or repeating your story to multiple intake coordinators.

Let us do the legwork. Submit your information and we'll find BCBS-accepting ABA providers in New York who have current availability — at no cost to your family.

Get Matched Now

Our matching service is completely free and works statewide. Whether you are in New York City, the suburbs, or a more rural part of New York, we work to identify the right BCBS-accepting ABA provider for your family. If your child has not yet received a formal ASD diagnosis and you are still in the evaluation process, we can still help you understand your next steps.