We might change insurance from Cigna to Blue Cross Preferred. We are in the process of the whole ADD evaluation with Cigna and the change would not go into effect for a couple of months. My concern are these exclusions that Blue Cross listed: 1. Counseling or behavior modification except those provided by Biodyne. 2. Services related to treatment of disturbances of conduct, disturbances of emotions, mental retardation, autism and learning disabilities. 3. Services not medically necessary as determined by BCBS.
My impression is that her condition would not be covered by the BC insurance or that it would take a fight to get coverage by BC. But I would like to hear from others who may know about BC and coverages. Thanks
I believe that the coverage can vary greatly, depending on which Blue Cross you have. We are covered under Blue Cross Federal Employee program and have had no problem with ADHD coverage. Of course, it also varies depending on what treatment you pursue. I believe that our Blue Cross has a limit to how many “mental health” exams you can have per year, and if you are going to have more than a certain number (10? not sure) you have to have a treatment plan made and pre-approved. My 10 year old goes in every 3 months for a “ritalin check” with his ped. and, as the doctor is a “preferred provider” Blue Cross covers all but the co-payment. Blue Cross also paid for his initial evaluations, but that was several years ago and who knows if that coverage has changed!
Before you make the switch, I would contact your local Blue Cross customer service rep. and get answers specific to your questions. Good luck