Improving Access to Mental Health Services

Blue Cross Vermont is taking another important step to increase your access to quality health care. In some situations, prior authorizations, also known as prior approvals, can be a barrier. Our work to remove these requirements, where possible, can help you get the care you need easier and faster.

Prior authorization is when a Vermont provider is required to get approval in advance from a health plan before a medical service is performed or a prescription is filled. Prior approvals help ensure the provider's recommended service or treatment is safe, necessary, and a wise use of your healthcare dollars. Prior approvals are not required for everything — only for certain procedures and medications specified by the health plan.

Beginning July 1, 2025, we are eliminating prior authorization requirements for applied behavior analysis. Applied behavior analysis, also known as ABA therapy, is a key treatment for individuals with autism. It can help them improve their social interactions and learn new skills. ABA therapy is used to encourage positive behaviors and reduce inappropriate behavior. Learn more about applied behavior analysis.

We are eliminating prior authorization for ABA therapy to make it easier and faster for families to access the care their children need. ABA therapy can be very useful during a child’s early developmental years, so we’re ensuring this service is available when it’s most beneficial.

“Autism has been in the national spotlight recently, with growing concerns about long waitlists, denied services, and barriers to care,” says Tom Weigel, MD, Blue Cross Vermont’s Chief Medical Officer. “Our decision to remove prior authorization for ABA therapy is a strong, timely response and a meaningful step forward.”

Expanding options for mental health care

We continue to improve our members’ access to mental health services in other ways. In 2023, we removed prior authorization requirements for mental and substance use disorder treatment for in-state, in-network facilities. That applies to various levels of care, including inpatient, residential, partial hospital, and intensive outpatient programs. Removing prior authorization enables patients to receive appropriate treatment earlier, which can help prevent the need for more intensive and costly forms of care later.

“Prior authorization often delays treatment, frustrates families, and burdens providers. By removing it, we are reducing red tape and promoting equitable access to care — especially important in rural areas where services are already limited,” notes Dr. Weigel.

We’ve also formed partnerships with three mental health telemedicine services to increase our members’ access to mental health providers:

• Amwell provides 24/7 virtual access to psychologists and counselors via their mobile app or website. Amwell’s therapists can treat a wide variety of conditions, including anxiety, depression, panic attacks, and trauma.
• SonderMind helps members find a provider in their area for in-person care or connects them virtually. Treatment is available for mental health conditions such as bipolar disorder, depression, and anxiety.
• Valera Health offers virtual therapy and psychiatry services for adults and children aged 12 and older. Clinicians are available via a mobile app or computer connection. Treatments include attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD).

Our members’ access to mental health therapists now exceeds the national benchmark for Blue Cross and Blue Shield plans throughout the country. We have more than 2,600 in-network mental health therapists, with 8.4 active therapists per 1,000 members — more than double the national Blue Cross plan average. Of those therapists, 41% are accepting new patients, which surpasses the 38% national average of other Blue Cross plans.

Dr. Weigel emphasizes, "We are committed to providing our members with timely access to services to support their mental health.”