Does Premera Cover ABA Therapy? A Guide for Washington Families

Yes. Premera Blue Cross covers applied behavior analysis for Washington children diagnosed with autism, with no age limit and no fixed cap on hours. Premera’s rulebook, medical policy 3.01.510, spends less time on approval paperwork than most insurers and more time on a long list of things ABA staff are not allowed to bill for. Knowing that list, and knowing exactly which Premera plan you hold, prevents most of the surprises families run into.

Premera, Premera Alaska, or a Premera-run employer plan?

Premera Blue Cross serves Washington residents and businesses everywhere in the state except Clark County, plus Alaska. The card in your wallet falls into one of four groups:

• Fully insured Washington plans. You or your employer buys a standard Premera policy. Washington insurance law and the 2014 settlement terms described below apply.
• Self-funded employer plans. Large employers such as Microsoft and Amazon pay claims themselves and hire Premera to run the plan. Premera’s ABA provider resources page says both follow Premera’s standard ABA process and fee schedule, and Premera publishes a separate autism benefit summary for Microsoft members. The employer’s Summary Plan Description sets the benefit, and federal ERISA rules govern appeals.
• Alaska plans. Premera Blue Cross Blue Shield of Alaska plans fall under Alaska insurance law. The 2014 Washington settlement covered Premera and LifeWise plans issued in Washington, so a family that moves from Anchorage to Bellevue checks the new plan’s booklet rather than assuming the old rules carry over.
• Federal employee plans. Washington members of the Blue Cross and Blue Shield Federal Employee Program go through a separate FEP prior authorization request for ABA, and that form states FEP pays nothing for ABA delivered in a school or as part of an educational program.

Ask member services one question first: “Is my plan fully insured or self-funded, and where is the ABA benefit written?” If your card says Regence, read our guide to whether Regence covers ABA therapy instead.

The 2014 settlement behind Premera’s coverage

In May 2014, Premera and LifeWise Health Plan of Washington settled three class actions brought by five people with autism: A.G. v. Premera and J.P. v. Premera in King County Superior Court, and R.H. v. Premera in federal court in Seattle. The families, represented by Sirianni Youtz Spoonemore Hamburger, argued that Premera’s developmental disability exclusion violated Washington’s Mental Health Parity Act.

Under the settlement, Premera agreed to cover medically necessary neurodevelopmental therapy, including speech, occupational, and physical therapy plus ABA, without the developmental disability exclusion, without age exclusions, and without treatment limitations. It also set aside $3.5 million to reimburse families for therapy they had paid for out of pocket. The terms apply to every insured plan Premera and LifeWise issue in Washington. Premera’s current ABA medical policy first took effect on November 10, 2014.

Who diagnoses, who treats, and how many hours

Diagnosis. Any healthcare professional whose license covers diagnosing psychiatric or neurodevelopmental disorders makes the autism diagnosis: a psychologist, psychiatrist, or developmental pediatrician, for example. Premera has no Center of Excellence requirement, unlike Apple Health, which sends many Medicaid families back for a second evaluation. Families with both plans should read whether Medicaid covers ABA therapy. Premera treats ABA for any diagnosis other than autism as not medically necessary.

Treating providers. A licensed behavior analyst leads the program in Washington, where the state licenses behavior analysts. Premera’s list also includes Washington agencies licensed by the Department of Health as behavioral health agencies with ABA on their license. Registered behavior technicians and licensed assistant behavior analysts deliver direct sessions under the lead clinician’s supervision. Premera’s provider page sets a supervision guideline of about two hours for every ten hours of direct treatment, with a two-hour weekly minimum.

Hours. Instead of a cap, Premera points providers to the Council of Autism Service Providers (CASP) practice guidelines for treatment intensity. The April 2026 revision swapped the old BACB reference for CASP’s 2024 guidelines and its 2025 paper on treatment intensity for young children. Our guide to how many hours of ABA therapy a child needs explains what those guidelines recommend.

Treatment plans. Premera’s provider page asks agencies to update each plan every six months and keep it on file, sending it in when Premera requests records.

Pre-authorization. The plan decides this, not the medical policy. In our experience, most Premera plans we bill have not required pre-authorization for ABA, so children start soon after the assessment. Some Premera-administered plans add their own authorization step, which is why the member services call matters.

Where ABA happens

Policy 3.01.510 lists home and clinic as the usual settings and adds community settings where your child’s difficulties show up. Telehealth has been fully covered since a January 2023 update that removed the earlier pandemic-only limits, for direct treatment, supervision, and parent coaching alike. Premera’s evidence review rates video outcomes as non-inferior to in-person care.

School is the tricky one. ABA staff deliver treatment at school only when autism-related behavior is a problem there, and every minute has to be real ABA treatment. Serving as a classroom aide, a 1:1 teacher, or anything on the IEP is the district’s job. Some Premera plans exclude school settings entirely, a point the April 2026 revision spelled out.

What Premera added in 2026

• March 2026: Premera added code 97152, a behavior assessment delivered by a technician under BCBA direction, and 97157, multi-family caregiver groups held without the children present.
• May 2026: Premera clarified that a child receives ABA and speech or OT as long as they happen in separate sessions, that parent coaching aimed at your own child’s treatment is covered, and that groups including typically developing peers are covered when a clinician, not a peer, leads them.

What Premera won’t pay for

Premera’s exclusion list runs longer than most. Under the policy, these fall outside the ABA benefit:

• Autism schools and tuition, including programs that describe themselves as ABA-based
• Camps of any kind, from summer camps to school-break day camps, even ones built for autistic children
• Respite, babysitting, live-in help, and training for nannies or au pairs
• Provider travel time and prep time, plus time spent charting without analysis
• Tagging along on outings, errands, or car rides unless your child has a documented pattern of behavior during those activities and the clinician is actively treating
• Treating siblings together, outside of true family or group sessions
• Two ABA agencies at once, except a short, specialized program such as an intensive feeding program that your main provider does not offer. Our guide on how to switch ABA providers covers the handoff.
• Sensory integration, auditory integration, hippotherapy, and pet therapy

How to appeal a Premera decision

Premera’s complaint and appeal rights FAQ sets the process for Washington members:

1. Deadline: 180 days from the date you receive notice of the decision.
2. How: Use Premera’s Member Appeal form or write to Premera Blue Cross, Attn: Member Appeals, P.O. Box 91102, Seattle, WA 98111-9202. The appeals fax is 425-918-5592. Include your BCBA’s letter and progress data; Premera accepts additional information with the appeal.
3. Urgent cases: If your provider believes a delay will harm your child’s health, Premera speeds up the review.
4. After the internal appeal: If Premera keeps the denial, it sends you your independent review rights. An independent review organization’s decision binds the insurer, according to the Washington Office of the Insurance Commissioner.

Fully insured members reach the OIC consumer hotline at 800-562-6900. ERISA plans, including most large-employer plans, add the U.S. Department of Labor’s Employee Benefits Security Administration at 866-444-3272. Our broader guide on appealing a denied ABA claim has letter templates.

How to verify your Premera ABA benefits

1. Is my plan fully insured, self-funded, or a Federal Employee Program plan?
2. Does my plan exclude ABA in school or educational settings?
3. Does my plan add a pre-authorization step for ABA, or does it follow the standard process?
4. How much of my deductible and out-of-pocket maximum have I met? On a high-deductible plan with an HSA, ABA’s first weeks hit that deductible fast. Our ABA cost guide and insurance terms explainer help with the math.
5. Is Orchid Academy in network for my plan?

Keep a log of each call with the date, representative’s name, and reference number.

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Orchid Academy is in network with Premera Blue Cross. Our intake team checks your plan type and school-setting rules before the first session, and we offer in-home and center-based ABA across Bellevue, Issaquah, Bothell, Kirkland, Sammamish, Covington, Federal Way, and East Wenatchee. See Orchid programs that accept Premera.

Request a call back with your Premera member ID and we’ll confirm your coverage and give you a start date. Browse our ABA insurance coverage guide for Washington or pick the closest Orchid location.