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Aetna’s Autism Coverage
Aetna is one of the few insurance companies in the United States that provides coverage for Applied Behavior Analysis (ABA) therapy for autism. ABA therapy is a type of therapy that is often used to treat autism spectrum disorders. Aetna’s coverage for ABA therapy is very comprehensive, and it covers a wide variety of services.
What Aetna covers
Aetna covers a range of services for people with autism spectrum disorder (ASD). These services are based on the recommendations of the individual’s treatment team, which may include a physician, psychologist, psychiatrist, licensed clinical social worker, speech therapist and/or occupational therapist. Aetna also offers a program called “Autism Speaks ® Autism Treatment Network (ATN),” which provides members with access to comprehensive, multidisciplinary care.
What Aetna doesn’t cover
Applied behavior analysis (ABA) is a type of therapy that can be effective in treating autism spectrum disorder (ASD). It is not currently a covered benefit under most Aetna health insurance plans. If you would like your child to receive ABA therapy you may be able to get coverage through an Aetna Special Needs Plan (SNP).
ABA therapy can be expensive, so it’s important to check with your health insurance provider before you start treatment. Some insurance companies will cover ABA therapy as a medical necessity, while others will not. If your child has a diagnosis of ASD, you may want to consider switching to a health insurance plan that covers ABA therapy.
How to get Aetna to cover ABA Therapy
ABA therapy is an effective treatment for autism, but it can be expensive. Aetna is one of the few insurance companies that cover ABA therapy. If you have Aetna insurance, you may be able to get some or all of the costs of ABA therapy covered.
Step One: Research
The first step is to find out if your child is eligible for ABA therapy. You can do this by contacting your local Autism Society or verifying coverage with your insurance company. If you have Aetna, you can verify coverage here.
If you find that your child is not currently covered for ABA therapy, don’t despair! There are still things you can do. The next step is to gather as much information as possible about ABA therapy and how it can help your child. The more knowledgeable you are about the subject, the better equipped you’ll be to make a case for coverage.
Some important things to keep in mind as you’re doing your research:
-ABA therapy is an evidence-based treatment for autism that has been shown to be effective in reducing autistic symptoms and promoting positive behavior change.
-ABA therapy is individually tailored to each child’s strengths and needs.
-ABA therapy requires a high level of commitment from both the child and the family.
-ABA therapy can be expensive, but there are ways to offset the costs (more on this later).
Step Two: Pre-authorization
If you are planning to use your Aetna insurance to cover the costs of ABA therapy for your child with autism, the first step is to get pre-authorization from Aetna. Pre-authorization is when Aetna reviews the request for ABA therapy and approves or denies coverage. To get pre-authorization, you will need to submit a request to Aetna that includes:
-Your child’s diagnosis
-The names of the therapists who will be providing services
-The frequency and duration of services
-The anticipated start date of services
Aetna will review the request and make a decision about coverage. If coverage is approved, you will be given a pre-authorization number that you can use to bill Aetna for the costs of therapy. If coverage is denied, you can appeal the decision or find another insurance carrier that covers ABA therapy.
Step Three: Documentation
Your doctor or ABA provider will need to document your child’s diagnosis, symptoms, and functional limitations. They will also need to explain how ABA therapy will help your child overcome these challenges.
Be prepared to provide Aetna with any documentation they request. This may include:
-A copy of your child’s diagnosis
-A description of your child’s symptoms
-A description of your child’s functional limitations
-A treatment plan from your doctor or ABA provider
-Progress reports from your child’s ABA therapy sessions
Step Four: The Appeal
If you have already tried steps one through three and you are still not getting the coverage that you feel you are entitled to, your next step is to file an appeal. You can do this by writing a letter to your insurance company outlining why you believe that they should cover the cost of ABA therapy. Be sure to include any supporting documentation such as letters from your child’s doctor or therapist.
It is important to remember that appeals can take some time, so be sure to start the process as soon as possible. In some cases, it may take several months for a decision to be made. If your appeal is denied, you can always try again or file a complaint with your state’s department of insurance.
Janice is a Board Certified Behavior Analyst. She graduated from the University of British Columbia with a Bachelor of Arts in Psychology and Special Education. She also holds a Master of Science in Applied Behaviour Analysis (ABA) from Queen’s University, Belfast. She has worked with and case managed children and youth with autism and other intellectual and/or developmental disabilities in home and residential setting since 2013.