Insurance Coverage for ABA Therapy: What’s Covered?

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As the focus on Autism Spectrum Disorder (ASD) expands, so does the number of people seeking ABA therapy. Many families are unaware that insurance usually doesn’t cover beyond a certain point and many find themselves with huge out-of-pocket costs.

The “insurance companies that cover aba therapy” is a question that many parents have asked when they are looking for insurance coverage for ABA Therapy. The insurance company will decide what is covered, so it’s important to know what your insurance covers before you start working with an ABA therapist.


Your kid has been diagnosed with autism spectrum disorder (ASD), and your doctor has suggested a treatment option you’ve never heard of. Is that treatment covered by your insurance?

For persons with ASD, applied behavior analysis (ABA) is commonly referred to as the “gold standard” of treatment. Many individuals feel that because of this, it is automatically covered by insurance.

The majority of insurance policies do cover autism therapy, however coverage varies by state and plan. The majority of the time, insurance will pay a significant percentage of the cost of ABA treatment.

Federal & State Requirements

Insurance companies used to be able to sit down and select what they would and would not cover. As a result, coverage was patchy, and some individuals paid for insurance that left them destitute after just a few illnesses. Legislators got involved, and now the plans you purchase must follow the rules.

Those rules may be perplexing. According to Autism Speaks, in the United States, there are two sorts of plans, each having significantly different coverage types. These are the following:

  • Plans that are fully insured. According to state law, a plan like this must offer benefits. What is covered is determined by your insurance carrier.

  • Plans that are self-funded. This strategy must comply with federal requirements, but not with state ones. What is and isn’t covered is ultimately decided by your company.

You may not be aware of the sort of plan you have. A large number of individuals do not. Autism Speaks provides an interactive tool to assist you with your search.

This information will assist you in determining where to file a benefit modification petition. Typically, you’ll start the discussion at the state level.

Autism coverage is required in many areas, although the benefits vary greatly. It’s possible that ABA coverage won’t be officially supported.

Data on several states was gathered by the American Speech-Language-Hearing Association. This is an example of a representative sample:

  • Arkansas: When administered by a supervised, board-certified specialist, ABA is covered.

  • If a plan covers physical therapies, it must also cover mental health services in California. ABA is a therapy for autism that is reimbursed by insurance.

  • Delaware: ABA treatment is covered, as well as any necessary goods or equipment.

  • Georgia: The ABA isn’t specifically mentioned.

  • Although ABA isn’t specifically covered in Indiana, treatment for autism and similar illnesses may be exempt from deductibles and restrictions.

  • Montana: The ABA isn’t mentioned at all. For children aged 8 and under, the cost of autism treatment might be regulated at $50,000 per year.

Each state has its own set of regulations and interpretations. The regulations are spelled out in almost every insurance policy you purchase. Moving to a different state may have a big influence on the expense of ABA for your family.

How Does ABA Get Covered by Insurance Companies?

Your coverage may differ from state to state, as well as from plan to plan.

Some insurance companies are eager to adopt ABA and provide it as a standard benefit. Others, on the other hand, are far more conservative.

When you compare plans side by side, you can see where there are disparities in coverage.

  • Cigna: Applied behavior analysis is covered by several plans. Before treatment can begin, your doctor must submit official ASD diagnostic documentation if you have a plan like this.

  • Blue Cross Blue Shield: This brand is sold by a variety of health insurers, and each plan is unique. For example, in Michigan, ABA is covered for persons under the age of 18. Some insurance plans, however, demand documentation or preauthorization before treatment may begin.

  • Aetna: Although ABA treatment is not specifically covered by Aetna, it may be permitted. Discuss the details of your coverage with the firm.

  • In 2012, Kaiser Permanente made waves in Oregon when it became the first firm in the state to voluntarily cover ABA. However, such coverage is not available in all plans in all states. Some plans in Washington, for example, do not offer coverage.

Every insurance policy comes with a coverage booklet. The vocabulary might be difficult to grasp, and the language is complex. However, if you look closely, you should be able to find out whether or not your plan covers ABA.

Whether you don’t see that information or aren’t sure if you’re reading the plan correctly, contact the customer support number on your membership card.

You Should Understand Insurance Terminology

Assume you don’t have health insurance or are looking for a new plan to help you pay for your child’s ABA therapy. What should you be on the lookout for? Speaking the insurance lingo might be beneficial.

A comprehensive dictionary of insurance words is available on HealthCare.gov. Here are a few things you may find useful:

  • After the insurance company has paid a bill, you will be requested to pay a copayment or coinsurance.

  • Before your benefits kick in, you must pay this amount as a deductible. Some services, including as wellness screenings, are not included. Even if you haven’t reached your deductible, you may get these procedures for free.

  • Out-of-pocket maximum: This is the most you’ll have to spend out of pocket for covered services per year. Copayments, deductibles, and coinsurance are all included in this figure, but premiums are not.

  • Providers and experts having contracts with your insurance company are part of your network. If you leave that network, you may be responsible for a larger amount of the cost or the whole payment.

  • Prior approval is required: Before you join up for a service, you must first acquire authorisation.

You may also come across phrases related to the sort of plan you want to buy.

  • HMO stands for “health maintenance organization,” and it refers to a kind of insurance distribution. To get insurance benefits, you usually have to go via a network of providers.

  • The term “preferred provider organization” (PPO) is an abbreviation that stands for “preferred provider organization.” You have a professional network to pick from, but you may still get some advantages if you go outside of it.

As you shop, you have options. Before you commit to a strategy, ask a lot of questions.

Get the Most Out of Your Insurance

You have health insurance, and you know that your kid will be able to get applied behavior analysis treatment via it. You’ve put in the effort, but there’s still more to be done. The decisions you make now will help you keep your bill as low as possible.

To get the most out of your advantages, do the following:

  • Recognizing the need of previous authorisation. Before you begin therapy, double-check that you have completed all necessary documents. If you skip this step, you may be liable for the whole amount. A formal diagnosis of autism and permission for a functional behavior evaluation are required for ABA.

  • Following the rules. According to experts, certain strategies need constant progress documentation. Your child’s behavioral technician may be required to present papers demonstrating the therapy’s effectiveness. You don’t have to do the paperwork personally, but make sure it’s done.

  • Continuing to be a part of the network. If you choose services recommended by your insurance carrier, you’ll save money.

  • It’s time to pay your premiums. Insurance only works if your expenses are paid on time. Put this invoice at the top of your monthly bill-paying priority list.

Your health insurance advantages are priceless and may help you save a lot of money. Following these simple steps can help you get the most out of your investment.

Most ABA providers will assist you in determining your specific level of coverage and the amount of money you will have to pay out of pocket. To acquire a firm estimate of your charges, speak with providers as well as your insurance company.


The “blue cross blue shield autism coverage” is a type of insurance coverage that provides assistance to those who need it. The best way to find out what’s covered, is to contact your insurance company or the insurer directly.

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