Is ABA Therapy Covered By Insurance?

How To Make Sure Your Child's ABA Therapy Is Covered By Insurance

Health insurance can be complicated, even more so when ABA therapy is involved. As an accredited ABA therapy provider for more than 20 years, we know exactly what you face as a parent of a child with autism. So, we’ve put together this short guide just for you, outlining key tips, insights, and definitions that can help you find the right health plan for your child’s needs.

Step 1: Find out if your current health plan covers ABA therapy.

There are two types of health plans offered by employers:

  • Fully funded/insured health plans, the traditional type of insurance offered by companies, are subject to state mandates that require ABA therapy to be covered. Both Texas and Colorado require ABA therapy benefits in all fully funded/insurance plans offered in their states.
  • Self-funded/insured health plans, where your employer becomes your insurance provider instead of a third-party, are NOT subject to the same state mandates as are fully funded health plans. However, a company can choose to cover ABA therapy if it wants.

Unsure if your current health plan offers ABA therapy benefits?

It’s easy to find out. Just call your employer benefits representative or the member services number on your insurance card and ask if your plan includes ABA therapy benefits and what those benefits are.

Step 2: If you need to shop for a new health plan, consider a child-only plan from the Healthcare Marketplace.

Since it’s common for young children with autism to need up to 40 hours of ABA therapy per week, a child-only plan can be a smart financial decision that enables your child to receive the recommended amount of therapy they need to reach their full potential.

You can purchase a child-only insurance plan through the Healthcare Marketplace. The ABA benefit is included in the “Essential Health Benefits” package. This package is required on all Marketplace plans in Texas and Colorado.

Healthcare Marketplace plans can only be purchased during Open Enrollment periods. For 2021, the Open Enrollment period is November 1 – December 15. Selecting a plan during Open Enrollment ensures that you have coverage starting January 1. If you do not purchase a plan by December 15, 2021, the only way you can get coverage is if you have a “qualifying life event”.

Step 3: Eliminate surprises by understanding the costs of your health plan ahead of time.

When looking for the right health plan, make sure to consider the following.

  • The deductible. You’ll have to pay this amount before insurance starts to contribute. Your deductible and your responsibility for paying it resets every year.
  • You’ll have either a copay or a coinsurance.
    • Your copay is a flat rate you’ll have to pay per visit to a provider, including for ABA therapy.
    • Your co-insurances in a percentage of the total charges that you will be responsible for paying, after you’ve paid the deductible.
  • The out-of-pocket maximum is also important to be aware of. This is the maximum amount you’ll have to pay for the entire year. Once you reach that amount, you won’t have any other out-of-pocket expenses for ABA therapy the rest of the year. Like your deductible, the out-of-pocket maximum also resets every year.

Need help?

Find a local agent/broker who can provide expert advice on your options and also get you signed up.

Or just email us here at The Behavior Exchange. We’d be happy to help guide you through the insurance process and get your child enrolled in ABA therapy at one of our hives in North Texas or Boulder, Colorado. A brighter future is possible for your child!

 

Written by Joe’L Farrar, M.Ed., CCC-SLP BCBA

 

The Behavior Exchange is a Behavior Health Center of Excellence® and an in-network provider.

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Ashvina attended University of Bombay and graduated with a Bachelors of Commerce. She got her Montessori Diploma in 1985 and taught ever since. Ashvina came to TBE in January of 2016 as Admin Assistant. During the years she got the opportunity to learn and work in different departments such as HR, Finance, Office Manager and Executive Assistant. Last summer TBE bought billing in house and her current focus area is Revenue Cycle Management. She is detail oriented and enjoys working with people. Ashvina volunteers to deliver meals to seniors and local shelters on the weekend. She loves to spend time with her family and grandkids. Ashvina loves her job because she enjoys hearing different points of view, and she feels her contributions help fuel the direction of our company.

Working with children comes naturally to Angela. Her mom was a special education teacher for 30 years and often had Angela join her for Take Your Child to Work Day. And in high school, Angela spent every summer as the nanny for a little boy with an autism spectrum disorder. It was this experience where her passion for working with children with autism started to blossom.

From there, she went on to graduate from Oklahoma State University with a Bachelor of Science in Human Development and Family Sciences. She learned about Applied Behavior Analysis (ABA) in a non-normative development class and from that moment knew that ABA would be her life’s work.

Angela moved to the DFW area shortly after and began working at The Behavior Exchange as a therapist. She worked on her Master’s in Behavior Analysis at the same time. A year after graduating, she earned certification as a Board Certified Behavior Analyst.

Now, as a Clinical Director at The Behavior Exchange, she brings a life-long passion to her work, holding a special place in her heart for children with limited language skills and working closely with families to develop healthy sleep habits.

Danielle’s passion for working with families is deeply personal and from the heart. Her younger brother has an autism spectrum disorder, and through their journey as a family, she found her purpose in life as an advocate for individuals with special needs.

After graduating from the University of North Texas with a degree in Human Development and Family Studies, Danielle began volunteering at The Behavior Exchange. She saw passionate therapists, meaningful change for clients, and families with hope for the future. After a summer of volunteering, she officially joined the team as Director of Admissions and found her home with The Behavior Exchange family.

With her extensive experience working as a client advocate with insurance providers, Danielle perseveres to help individuals of all ages and abilities receive the services they need to reach their full potential. She feels truly honored by each and every family who entrusts The Behavior Exchange to be part of their journey and is committed to the organization’s core values, mission, and goal of being a beacon of hope for the community.

Adam has always had a passion for helping individuals of all ages thrive and reach their full potential. He’s also an enthusiastic musician, songwriter, leader, and devoted family man, who has been helping children and team members grow with The Behavior Exchange since 2010.

Prior to joining the team at The Behavior Exchange, Adam was a mortgage loan consultant and grad student, pursuing his master’s degree in Education at the University of North Texas. He graduated in 2013 and also earned a graduate academic certificate in Autism Intervention. The following year, after years as a Behavior Therapist and seeing first-hand the power of ABA and the meaningful impact it can have on children and their families, Adam became a Board Certified Behavior Analyst. He then commenced from the Stagen Leadership Academy after completing the Integral Leadership Program (ILP), a 52-week practice-based program designed to develop executives serious about transforming themselves, their teams, and their organizations.

Adam is truly grateful to be a part of a dynamic, inspiring and compassionate team, and he’s dedicated to bettering the lives of all children and their families through the delivery of the highest quality of ABA services, while supporting the amazing team at The Behavior Exchange.

Soraya is from South Africa and moved to Texas in 1996. She graduated from The University of Texas and pursued a career, at that time, in Education. Soraya taught at a Montessori school for a few years and then took on a leadership role.

During her time in the education system, Soraya realized her passion was to assist children with special needs. So she joined The Behavior Exchange as a therapist, transitioned into a supervisory role in 2017, and a year and a half later, was promoted to Clinical Operations Manager.

She quickly learned the ins and outs of ABA operations and scheduling and successfully collaborates across departments to ensure The Behavior Exchange continues to provide quality services to clients and their families. She’s thankful to be part of such an amazing organization and excited to see what the future holds.

You could say Walter’s career started when he spent hours as a young child drawing superheroes and coloring maps. This passion, along with extraordinary swimming skills, landed him a full swimming scholarship at Texas Christian University, where he graduated in 1997 with a Bachelor of Fine Arts in Communication Graphics.

During the next 13 years, his design and art direction skills, conceptual-thinking abilities, and marketing-savvy know-how were honed at a few prestigious advertising and marketing agencies around the Dallas area. In the mid 2000s, he helped his wife Tammy Cline-Soza (founder and CEO of The Behavior Exchange) create a unique and concise brand for her new business. From logos and websites to uniforms, brand voice and visuals, Walter has been the main creative force for all things The Behavior Exchange.

Aside from giving birth to The Behavior Exchange brand, Walter is helping Tammy raise two amazing, beautiful children, River and Sierra. In his spare time (the two minutes he’s got per week), you can find Walter illustrating iconic landmarks of Dallas and Texas or looking around for this next open-water swim. Once he gets back in shape.

After 20 years of building The Behavior Exchange, literally from the ground up,
Tammy couldn’t be more proud of the team, culture, and organization that it has become.

As a family helping families, The Behavior Exchanges looks for opportunities that will make the biggest impact and produce life-changing outcomes – for clients, families, and even for team members. Tammy believes that if a team, a family, a community takes care of each other, the possibilities are endless and the relationships built along the way can make life more enriching and challenges easier to navigate. You could say her goal has been to build a kind of utopia full of support, love, and expertise that brings the best services possible to the community and ensures more families have access to those services.

Tammy and her family have dedicated their lives to the mission of The Behavior Exchange and continue to grow, learn, cultivate, challenge, support, and create better models for success. To that end, she is committed to her own leadership development and actively participates in advanced training, mentoring, and deep self-exploration on how to live out her purpose to love and support her family and help others reach their full potential. She takes her position very seriously and tries to serve as a channel for what the universe wants to come to fruition.

She also loves travel, gardening, being creative, MUSIC!, tennis, yoga, meditation, journaling, reading, being in nature, adventures, and more than anything, spending time with her husband Walter and their two beautiful children, River and Sierra.