Exploring Insurance Coverage for Applied Behavior Analysis (ABA)
Interventions for autism spectrum disorder can be very expensive. Services for children on the autism spectrum may involve various medical professionals (e.g., psychiatry, neurology, etc.), speech & language therapy, occupational therapy, physical therapy, Applied Behavior Analysis (ABA), and respite therapy. The cost for these therapies can be high, particularly for individuals with higher support needs, and can lead to additional stress on the caregivers.
Fortunately, many of these therapies are either fully or partially covered by medical insurance, including many state Medicaid plans. Insurance companies exist to help cover some or all of the costs associated with medically-necessary treatments for numerous health conditions, including many therapies for those on the autism spectrum. Accessing medical coverage for 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, usually a medical doctor or a licensed psychologist, but this may vary by state. This is called a diagnostic evaluation or comprehensive diagnostic evaluation (CDE). 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 provider in your area who is registered with the Behavior Analyst Certification Board, or BACB, or a local company that provides these services. The Board certified Behavior Analyst (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. Where can you find these individuals or companies? You can search the BACB’s website to locate a provider in your area, contact your insurance company for a list of in-network provider agencies, or simply search for ABA companies near you in your preferred search engine to get started.
Once you locate the provider or agency you want to work with, they will likely submit a verification of benefits (VOB) to determine the specific terms of coverage for ABA services. They will then submit a request to your insurance company, called an authorization request, to begin the initial assessment. 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.
If you’re interested in determining if you or your child qualifies for ABA services through your insurance carrier or a medicaid plan, please contact Inspire ABA’s team today at 727-213-8851 or using our contact form.