Is ABA Therapy Covered by Insurance?

What is ABA therapy?

Applied behavior analysis therapy is a gold standard in care for children diagnosed with autism spectrum disorder (ASD). It uses the science of learning to help children develop practical, everyday skills through positive reinforcement. At Action Behavior Centers, our evidence-based approach focuses on unlocking each child’s strengths and preparing them for the future.

ABA therapy helps children learn and grow in key areas, including:

• Communication skills: Building verbal and nonverbal communication, like speaking, making eye contact, and understanding others
  
  
• Social skills: Practicing turn-taking, playing with peers, and starting conversations
  
  
• School readiness skills: Learning early academic skills like matching, sorting, and following instructions
  
  
• Behavior support: Addressing the root causes of unsafe behaviors like self-injury, aggression, or elopement by teaching safer, more effective ways to meet their needs

How does ABA therapy help children with autism?

ABA therapy helps children with ASD build independence, prepare for school, and develop essential skills that carry over into everyday life. Parents also receive training so they can use therapy strategies at home.

At ABC, each child is assigned a Board Certified Behavior Analyst (BCBA) who sets individualized goals for therapy in collaboration with families. Our clinicians use real-time data to track progress and adjust therapy goals as needed, making sure your child continues to have meaningful outcomes.

Does insurance cover ABA therapy?

Yes, ABA therapy is often covered by insurance. But the exact coverage depends on your plan, your provider, and whether your child has an autism diagnosis. At Action Behavior Centers, our intake team is here to help you understand your insurance benefits and get started as quickly as possible.

Here are a few things that may affect your insurance coverage:

An autism diagnosis

ABA therapy is a gold standard in care for children diagnosed with autism spectrum disorder. Most insurance companies require a formal autism diagnosis in order to cover ABA therapy. Under the Affordable Care Act (ACA), most health plans are required to cover autism services, including ABA therapy, for children with an ASD diagnosis.

Insurance plan type

Insurance coverage can look a little different depending on your plan:

• Private insurance: Many providers, including Blue Cross Blue Shield, UnitedHealthcare, and Aetna, cover ABA therapy for children with autism. Coverage amounts and requirements vary by plan.
• Medicaid: In many states, Medicaid covers ABA therapy. Coverage rules can vary by location, so it’s best to check with your state’s Medicaid office. Please note: We do not accept Medicaid at our ABA therapy centers in Texas, Illinois, or Minnesota at this time.
• Employer-sponsored plans: Most job-based health plans include some coverage for ABA therapy. The exact details will depend on your employer and insurance provider.

Some insurance plans place age or hour limits on ABA therapy. Many policies cover care through age 21, but the number of approved hours may vary. Our teammates will help you understand what’s included in your plan.

Who provides therapy and where

Most insurance plans require that ABA therapy be provided by a licensed or certified professional, like a BCBA. Some plans may also require therapy to happen in certain settings, such as center-based ABA therapy, home-based ABA therapy, or ABA for school-age children.

How to verify ABA therapy insurance coverage

If you’re not sure whether your insurance covers ABA therapy, here are some simple steps you can take:

1. Call your insurance company

Reach out to the number on the back of your insurance card and ask about ABA therapy. You can ask:

• Does my plan cover ABA therapy for autism?
• Are there age limits or limits on how many hours are covered?
• Do I need a referral or approval before starting?
• Do I have to use certain providers?

2. Get a formal diagnosis

Most insurance companies will only cover ABA therapy if your child has a documented autism diagnosis. This needs to come from a licensed healthcare provider. If you need help getting a diagnosis, ABC offers no-cost diagnostic support to help you take the next step.

3. Review your benefits

Once you know ABA therapy is covered, take a look at your insurance plan. Check for things like copays, deductibles, co-insurance, and limits on services.

4. Don’t give up if you get a denial

Sometimes, insurance denies coverage by mistake, often because of missing paperwork or a billing code error. If this happens, keep a record of everything and follow the appeal steps listed by your insurance provider.

How to pay for ABA therapy at Action Behavior Centers

At Action Behavior Centers, we believe that every child should have access to high-quality ABA therapy, no matter their family’s financial situation. That’s why we offer several ways to make ABA care more affordable:

• Help with out-of-pocket costs
  We help families manage their maximum out-of-pocket (MOOP) expenses. This is the most your family would pay for covered healthcare in a year before insurance pays 100% of the rest. Our team can walk you through your plan and help you understand what to expect.
  
  
• Sliding-scale payment options
  We understand that every family’s budget is different. That’s why we offer sliding-scale options based on your income. You’ll only pay what your family can reasonably afford after insurance coverage is applied.

In-network with major insurance providers

ABC is proud to be in-network with many of the largest insurance companies in the states we serve, including:

• Blue Cross Blue Shield
• Aetna
• United Healthcare
• Cigna
• Ascension
• Optum
• UMR
• PHCS
• Beacon Health Options
• Medica

We’re always adding more insurance partners, so give us a call and we’ll be happy to check your specific plan. Please note: We do not accept Medicaid at our ABA therapy centers in Texas, Illinois, or Minnesota at this time.

Get started with ABA therapy today

If you’re thinking about ABA therapy for your child, we’re ready to help. Reach out to learn more about our services and how personalized ABA therapy can support your child’s growth. Contact us today to schedule a tour and take the first step toward milestone moments.