One of the most common surprises for parents starting the ABA journey is the first time they see their “patient responsibility” on a bill. Even with great primary insurance like Blue Cross Blue Shield of Texas (BCBSTX), the combination of deductibles and per-session copays can add up quickly.
When this happens, many parents start to wonder: Can my other insurance help?
If your child is covered by two different plans—perhaps one through each parent’s employer, or a combination of BCBSTX and Texas Medicaid—you are dealing with a process called Coordination of Benefits (COB).
In the world of autism therapy, having secondary insurance can feel like a safety net, but it also adds a layer of complexity to an already confusing system. As a clinician who has walked families through insurance confusion many times, I want to help you move from overwhelmed to informed.
What is ABA therapy and “Medical Necessity”?
Before diving into the insurance “how-to,” it’s helpful to ground ourselves in the basics. Applied Behavior Analysis (ABA) is an evidence-based therapy that focuses on teaching functional skills—like communication, social interaction, and self-care—while reducing behaviors that might be harmful or interfere with learning.
Because ABA is often intensive, insurance companies like BCBSTX only cover it if it is deemed medically necessary. This means a doctor or specialist has determined the therapy is vital for your child’s health and development. According to BCBSTX provider guidelines, this often requires a formal diagnosis of Autism Spectrum Disorder (ASD) from a qualified specialist.
What exactly is “Secondary Insurance”?
Simply put, secondary insurance is a second health plan that may pay for costs that your primary insurance does not cover. Think of it as a backup player. It doesn’t replace your main plan; it steps in to potentially help with the “gap” left behind, such as your deductible, coinsurance, or copays.
Parent Tip: BCBSTX is almost always the primary insurer if it is provided through an employer. Secondary insurance can be a massive help, but only if the “Coordination of Benefits” is set up correctly from day one.
How does secondary insurance work with BCBSTX for ABA therapy?
The most important thing to understand is that insurance companies don’t just “split the bill.” They follow a very specific order of operations.
What is Coordination of Benefits?
Coordination of Benefits is a set of rules that determines which insurance company pays first (Primary) and which pays second (Secondary). This prevents “double dipping” where two companies might accidentally pay for the same service twice.
For children, the most common way to determine the primary plan is the Birthday Rule.
The parent whose birthday (month and day) falls earlier in the calendar year holds the primary plan.
The other parent holds the secondary plan.
Note: Year of birth does not matter—only the month and day.
When does secondary insurance help?
If everything is aligned, your secondary plan can be used to cover:
Your Primary Deductible: If BCBSTX says you owe $2,000 before they start paying, the secondary plan might pay that $2,000 for you.
Copays and Coinsurance: If you have a $40 copay for every ABA session, the secondary plan may “pick up” that $40. As noted in the BCBSTX Coordination of Benefits guide, once the secondary payer processes the claim, you should only be responsible for the amount shown on their final statement.
Understanding your BCBSTX plan type
Not all BCBSTX plans behave the same way.
Employer-Sponsored Plans: These are the most common and generally have robust ABA benefits due to the Texas Autism Insurance Mandate.
Self-Funded / ERISA Plans: Some large companies manage their own insurance funds. These plans are not always subject to Texas state mandates, meaning their rules for secondary coverage can be much stricter.
Marketplace Plans: These are individual plans bought on the exchange. They have specific rules about how they coordinate with other “on-exchange” plans.
Quick Takeaway: Never assume your secondary insurance will automatically pay. You must confirm that your ABA provider is in-network with both plans and that both plans have “accepted” their roles as primary and secondary.
Frequently Asked Parent Questions About Secondary Insurance
Can Medicaid be used as secondary insurance with BCBSTX? Yes, and this is very common in Texas. BCBSTX STAR Kids guidelines explain that for children with dual coverage, BCBSTX is the primary payer and Medicaid is the “payer of last resort.”
Will secondary insurance cover my deductible or copays? In many cases, yes. However, it depends on the “Allowable Amount.” If the secondary insurance’s allowed rate for a session is lower than what the primary already paid, they may not pay anything additional.
Do both insurance plans need to authorize ABA therapy? Usually, yes. You might get a “Yes” from BCBSTX, but if you don’t also get a prior authorization from the secondary plan, they may deny the claim for the “gap” amount.
Does secondary insurance affect how many ABA hours are approved? Generally, no. The number of hours is based on the medical necessity determined in the assessment. The primary insurance (BCBSTX) typically sets the clinical “speed” of the case.
Can I choose which insurance is primary? Unfortunately, no. The insurance companies follow legal COB rules strictly. You cannot choose which plan to use first based on which one has a lower deductible.
Does secondary insurance slow down the approval process? It can. Because we often have to wait for the primary authorization before the secondary will even look at the file, it can add 1 to 2 weeks to the initial startup time.
The Real-World Scenario: The Parker Family
To see how this works in practice, let’s look at the Parker family. Their daughter, Mia, was covered by her Dad’s BCBSTX plan (Primary) and her Mom’s Cigna plan (Secondary).
The Setup: Dad’s birthday is in March; Mom’s is in October. Therefore, BCBSTX was Mia’s primary insurance.
The Benefit: Mia’s BCBSTX plan had a $40 copay per session. Because they were doing 20 hours of ABA a week, those copays were becoming a major financial burden.
The Outcome: Because Mia’s provider was in-network with both BCBSTX and Cigna, the provider was able to bill the $40 “leftover” amount to the Cigna plan. Cigna covered $35 of that $40, reducing the Parkers’ out-of-pocket cost to just $5 per session.
The Lesson: This only worked because the Parkers updated their “Coordination of Benefits” with both companies before therapy started. Had they waited, the claims would have been stuck in “pending” status for months.
How Bright Pathway ABA supports your family
Navigating two insurance companies is, quite frankly, a lot of work. At Bright Pathway ABA, we believe your focus should be on your child’s progress, not on hold with an insurance representative.
Free Insurance Benefit Checks: We don’t just look at one plan; we look at both. We help you understand exactly how they will interact.
Coordination-of-Benefits Review: We help you navigate the “Birthday Rule” and ensure both companies have the correct information to prevent claim denials.
Handling the Paperwork: We manage the prior authorizations for both the primary and secondary plans.
Home- and School-Based Services: We provide expert ABA across Texas, ensuring your child receives care where they can best succeed.
Next Steps: What should you do right now? If your child has Blue Cross Blue Shield of Texas and a secondary insurance, our team can help you understand how the plans work together — at no cost to verify benefits. Reach out to us today to start the verification process.
Insurance is overwhelming. It is a language all its own, and it’s okay if you don’t have it all figured out yet. You aren’t expected to be an insurance expert—you just need to be a parent. With the right support and a clear “Coordination of Benefits,” the financial path to ABA therapy can become much smoother.
Disclaimer: This article is for informational and educational purposes only and does not constitute medical, clinical, or insurance advice. Coverage varies by plan and policy. Always confirm your specific benefits directly with Blue Cross Blue Shield of Texas or your plan administrator. Bright Pathway ABA provides assistance with insurance verification but cannot guarantee approval or coverage levels.
