Blue Cross and Blue Shield of Texas (BCBSTX) is dedicated to ensuring members have access to comprehensive behavioral health services, including support for mental health and substance use disorders. For families in Texas navigating the complexities of autism spectrum disorder (ASD), understanding insurance coverage for diagnosis is crucial. BCBSTX provides resources and coverage to help STAR Kids members access the necessary evaluations and treatments for autism.
Accessing behavioral health care through BCBSTX is designed to be straightforward. Importantly, you do not need approval from your child’s primary care provider (PCP) to seek behavioral health services. For outpatient care, prior authorization is also not required. A dedicated behavioral health service coordinator is available to assist you in finding in-network providers that meet your family’s needs. For medically necessary services within the network, authorizations are not needed, simplifying the process of getting care for your child. If you choose an out-of-network provider, it is recommended to work closely with your service coordinator to ensure proper arrangements are made for your child’s care and appropriate payment processing.
BCBSTX offers a range of support services to assist families in managing behavioral health challenges. These services include medication management to alleviate symptoms and promote independence, training programs focused on enhancing communication within families and with educators to collaboratively manage symptoms, and support for navigating mental or emotional crises.
For children suspected of having Autism Spectrum Disorder, BCBSTX STAR Kids plan includes coverage for Applied Behavior Analysis (ABA) therapy. ABA therapy is a recognized and effective treatment that can significantly improve the functional abilities of children with ASD in their interactions with peers and caregivers. To access ABA therapy benefits, a formal diagnosis of ASD is a necessary first step. This diagnosis requires specialized testing that goes beyond standard pediatric evaluations. BCBSTX mandates that this comprehensive testing be conducted by specialists such as developmental pediatricians, neurologists, psychiatrists, licensed psychologists, or specialized autism diagnosis teams. If you believe your child may have autism, the initial step is to consult with your child’s pediatrician to obtain a referral to one of these qualified specialists for diagnostic evaluation.
In addition to direct services, BCBSTX also provides access to the Learn to Live program, a no-cost online behavioral health resource available to members aged 13 and older, as well as caregivers. This platform offers self-paced modules addressing common mental health concerns such as stress, anxiety, depression, insomnia, and substance abuse. Members also have access to 24/7 therapy coaches, providing continuous support and guidance. To explore this online resource, you can register at Learn to Live using the access code TXMED.
For urgent situations, BCBSTX offers robust emergency and crisis support. If you believe your child is experiencing a mental health emergency, immediate assistance is available 24/7 by calling 1-877-688-1811 (TTY: 711). This hotline connects you directly with a mental health professional at any time, day or night. Furthermore, confidential mental health hotlines are accessible around the clock, offering another layer of immediate support at no cost.
BCBSTX, through the STAR Kids plan, also provides mental health rehabilitation services, including counseling, treatment, and skills training. These services are designed to facilitate long-term improvement in your child’s mental health and also address substance use rehabilitation needs through specialized counseling and treatment programs.
For further details regarding ABA therapy, BCBSTX provides a comprehensive FAQ document. To find ABA therapy providers in your area, you can utilize the Provider Finder®. If you have additional questions about ABA services or need assistance, the STAR Kids Service Coordination line is available toll-free at 1-877-301-4394 (TTY: 711), operating from 8 a.m. to 5 p.m. Central Time, Monday through Friday. More information about behavioral health services can be found in the STAR Kids Member Handbook. BCBSTX is committed to supporting families in accessing the autism diagnosis and behavioral health services their children need.
