Being your insurance advocate is part of our holistic approach to ABA therapy.
As we write this, a new year is upon us. For many families, a new year means a new health insurance plan. Even if you have the same plan as last year, navigating insurance can be difficult especially when it comes to autism services, such as the gold standard treatment of ABA therapy.
That’s where we can help. We have years of experience working with insurance companies on behalf of families and children in our care. We work as your advocate to help you understand and maximize your benefits and ensure your child receives all the therapy hours they need to reach their goals, and ultimately, their full potential.
How Insurance Works for Autism Service
All 50 states now require health insurance companies operating in their states to offer coverage of clinically necessary treatments for autism, such as ABA therapy. While that’s good news for families, coverage limits and requirements can vary by state. Autismspeaks.org offers handy links to each state’s regulated insurance coverage. Just click: Texas Colorado All States
One of the common requirements for accessing insurance benefits for services like ABA therapy is an autism diagnosis. One exception is in Colorado. The state’s Medicaid plan accepts a number of diagnoses in addition to autism, including developmental concerns.
Since ABA therapy and other treatments for autism are administered over a prolonged period of time, your service provider will need to ask your insurance company to authorize the required hours. They do that by submitting a treatment plan they’ve created for your child.
Authorization can take up to a week or longer, and there could be questions your service provider will need to answer before authorization is given. Authorizations for ongoing treatment typically span a 6-month period.
We encourage families to use all of the therapy hours authorized for their child. If not, your insurance company could assume your child doesn’t need as many hours of therapy anymore and deny hours your child needs when authorization is sought the next time.
More Insurance Tips for Parents of Children with Autism
- Most insurance companies require a standardized assessment conducted by an MD (medical doctor) or licensed psychologist. A school report is not enough.
- It’s better to think about costs on an annual basis. Once you meet your annual out-of-pocket maximum, copays and coinsurance will no longer apply.
- Insurance companies can limit the number of therapy hours they cover. We advocate on your behalf to ensure your child gets the therapy they need.
- Participate in Parent Training, because insurance companies want to see you involved in your child’s ABA therapy.
You’re Not Alone!
Our ABA therapy and insurance experts are ready to lend a hand with answers to all your questions and a path to a brighter future for you child and family.
Early intervention is the key to long-term success for your child, so don’t wait to seek treatment after you’ve received a diagnosis. Our fun, early-start program – B.E.E.S. – is ideal for preschoolers. In fact, children as young as two can benefit from ABA therapy.
Get started today! Our experts can help.
The Behavior Exchange is proud to be a Behavioral Health Center of Excellence® with the highest level of accreditation possible. We’re also in-network with major insurance providers in both Texas and Colorado.