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How is ABA Covered by Insurance Companies?

Interventions for autism spectrum disorder can be very expensive. Services for children on the spectrum may involve speech language therapy, occupational therapy, behavior therapy (including ABA), psychotherapy, and respite therapy. The monthly cost for therapies and additional prescribed medications can be costly and lead to additional stress on the caregivers.

Fortunately, some of these therapies are fully or partially covered by medical insurance, including many Medicaid plans. Insurance companies exist to help cover the cost of medically-necessary treatment,  including many therapies for those on the autism spectrum. Accessing coverage for autism-related therapies can ease the financial burden on families, as well as ensure that children who need life-changing treatment receive the quality care they deserve. Below we discuss how ABA therapy is covered by insurance companies, and the steps involved to access coverage for ABA services.

The first step in accessing insurance coverage for your child on the autism spectrum is having the diagnosis verified by a qualified medical professional. This can often be completed or verified by a medical doctor or a licensed clinical psychologist. The diagnostic report from the evaluation must specifically include autism spectrum disorder as a diagnosis and be signed be a qualified medical professional. Additionally, the diagnostic evaluation must include a statement that ABA services are medically-necessary or a separate letter of medical necessity must be obtained stating that ABA services are medically necessary. This serves as the “prescription” for ABA services from your diagnostic professional. In many cases, reports and assessments from several of these professionals are needed to satisfy requirements for an autism diagnosis.

The next step will be to locate a reputable and qualified ABA therapist who is registered with the Behavior Analyst Certification Board, or BACB, or a local company that provides these services in your area. The Board certified Behavior Analyst, or BCBA, will serve as the lead clinician for your child and will supervise other professionals who may also provide services. In addition to being board certified as a behavior analyst, some states require BCBAs be licensed as behavior analysts in order to practice in that state. Finally, BCBAs must be credentialed with an insurance company to be eligible for reimbursement of ABA services provided to members of that insurance policy.

You can then proceed to submit a claim, citing that your child is diagnosed on the spectrum and qualifies for behavioral therapy; this is defined as the scientific and conceptual reconfiguring of consequences and the environment to impact socially significant behavior. Many companies that specialize in providing ABA services will ensure that the BCBA is appropriately credentialed with your insurance carrier and will assist with billing all insurance claims.

Early detection and intervention may significantly increase chances of being qualified for insurance coverage for ABA autism treatment. Some insurance companies impose age limits for children who they will cover for the first time, as well as those whose coverage they will renew. This is a critical piece of information for parents and caregivers to know. Early detection is often linked to recognizing the warning signs of autism, so that immediate assessment or consultation can take place with a medical professional. The average age for developing ASD symptoms is between 1-3 years. However, diagnosis often comes much later, between 2 ½  – 6 years of age. Below are some signs that warrant immediate consultation with a doctor:

  • Loss of previously acquired skills
  • Lack of speech
  • Not answering to name
  • Lack of eye contact
  • Lack of joint attention
  • Hand flapping
  • Head rocking
  • Tip toeing
  • Lining up toys
  • Echolalia – ( the monotonous repeating of words)
  • Isolated play

Stay tuned to this blog for more advice and information on autism-related ABA therapy!