Insurance coverage & financial assistance
Navigating insurance for applied behavior analysis (ABA) therapy can feel overwhelming. At Action Behavior Centers, we simplify the process so you can focus on supporting your child. Our dedicated insurance specialists work directly with your provider to make sure everything runs smoothly from the start.
Action Behavior Centers accepts most insurance providers:
We simplify insurance for ABA therapy
Action Behavior Centers is proud to partner with many of the largest health insurers in the states we serve. Most families find that their coverage includes ABA therapy for autism spectrum disorder (ASD), and we’re here to help guide you every step of the way.
Here’s how we support your family:
Insurance verification
We call your insurance company to verify your child’s ABA therapy coverage, deductible information, and any out-of-pocket costs.
Pre-authorization support
If required, we submit all paperwork to your insurance provider to confirm medical necessity for ABA therapy.
Direct billing
After each ABA therapy session, we submit claims directly to your insurance company for hassle-free payment.
In-network vs. out-of-network coverage
Here’s how Action Behavior Centers can help your family.
At Action Behavior Centers, we are credentialed and contracted with major insurance providers. This means we have a specific agreement that outlines our rates with each payer. For families, this makes a big difference: in-network coverage almost always means your out-of-pocket cost is much lower than out-of-network coverage.
In-network insurance providers
Action Behavior Centers is in-network with many of the largest health insurers across the states we serve. Families often find that their plan includes coverage for ABA therapy, and our insurance specialists will confirm the details for you. We currently work with:
- Blue Cross Blue Shield
- Aetna
- United Healthcare
- Cigna
- Ascension
- Optum
- UMR
- PHCS
- Beacon Health
- Options
- Medica
At this time, we do not accept Medicaid at our ABA therapy centers in Texas, Illinois, or Minnesota. We are always expanding our network of accepted providers. Please contact us to confirm your specific plan.
Your total responsibility depends on your plan’s maximum out-of-pocket (MOOP) amount. ABC will never charge more than your MOOP. MOOP is the highest amount your family will pay for covered healthcare services in a year before your insurance covers 100% of the remaining costs. Once your deductible and out-of-pocket maximum are met, most or all of your child’s ABA therapy may be covered.
What affects the cost of ABA therapy?
- Therapist credentials: All ABA services are billed under a BCBA, but costs may vary depending on provider qualifications.
- Location: Rates differ by state and region.
- Therapy hours: More therapy hours lead to a higher overall cost.
- Insurance coverage: Deductibles, copays, and limits on ABA therapy hours vary by plan.
How much does ABA therapy cost in the U.S.?
The cost of ABA therapy varies based on your child’s needs, your insurance plan, and where you live. Families paying out of pocket often find that insurance covers most, or sometimes all, of the expense, particularly once their deductible or MOOP has been met.
How much does ABA therapy cost in the U.S.?
All private commercial health insurance companies and Medicaid programs in the U.S. cover ABA therapy to some degree. Since coverage can be complex, our insurance specialists verify your benefits for you.
We provide clear information on:
- Your out-of-pocket costs
- How many ABA therapy hours your insurance covers
- The number of ABA therapy hours recommended by your child’s clinical team, based on a thorough assessment of their unique needs and your family’s goals
What affects the cost of ABA therapy?
Several factors can impact how much your family pays for ABA therapy:
- Therapist credentials: All ABA services are billed under a BCBA, but costs may vary depending on provider qualifications.
- Location: Rates differ by state and region.
- Therapy hours: More therapy hours lead to a higher overall cost.
- Insurance coverage: Deductibles, copays, and limits on ABA therapy hours vary by plan.
What if my insurance requires a prior authorization?
Some insurance plans require a prior authorization before your child can begin ABA therapy. This step confirms that therapy is medically necessary and that your insurance will cover the services.
The process usually involves:
- Our clinicians complete a thorough assessment of your child’s needs and your family’s goals, then recommend an appropriate number of therapy hours.
- Our insurance team compiles the documentation and submits a request to your insurance provider.
- The insurance company reviews the request, which typically takes 7–14 business days.
- We receive either an approval or, if denied, we work with you on the next steps, which may include filing an appeal.
At Action Behavior Centers, we approach each child individually. Our goal is to make sure your insurance company has the information needed to understand your child’s needs and approve the right level of care without unnecessary delays.
Financial assistance for ABA therapy
At Action Behavior Centers, we believe every child deserves access to ABA therapy, no matter their family’s financial situation. We know that costs, especially when reaching your maximum out-of-pocket (MOOP) limit, can feel overwhelming.
Here’s how we can help ease that burden:
- Insurance navigation: Our team will review your benefits, explain your coverage, and walk you through your options.
- Charity Care program: Families who qualify under federal poverty guidelines may receive financial assistance based on their income level.
Many families qualify for ABA therapy at little to no cost once insurance and financial assistance are applied. More importantly, we make the process fast, simple, and supportive because getting started with ABA therapy should never be delayed by finances.
Each U.S. state has specific laws that mandate health insurance plans to cover autism-related services for children. However, the extent of these autism benefits by state can vary, with certain exceptions for consumer choice or small-business plans (those with 50 or fewer employees).
Arizona
In Arizona, the "Arizona Autism Mandate" requires insurance plans to cover the diagnosis and treatment of autism, including ABA therapy, ensuring individuals with autism have access to necessary therapies. This mandate, established through House Bill 2847, became effective in 2008.
Colorado
Colorado’s 2009 Senate Bill 09-244 requires most major insurance plans to provide diagnostic support and treatment for children with autism. In 2015, Senate Bill 15-015 removed all age and dollar caps on autism care, including for applied behavior analysis services.
Connecticut
Connecticut’s 2009 autism insurance bill, Substitute Senate Bill 301/Public Act 09-115, provides comprehensive autism coverage for children. Services covered by this law include diagnostic support and behavioral therapies, such as ABA, speech therapy, occupational therapy, and physical therapy.
Georgia
Georgia’s autism insurance bill, Senate Bill 118, was passed in 2015. It covers the following autism-related services for individuals under 21 years old: diagnosis support, applied behavior analysis, counseling services, and speech, occupational, and physical therapy.
Illinois
Public Law 095-1005 in Illinois mandates certain health insurers to cover the diagnostic support and treatment of autism spectrum disorder for individuals under 21 years old. Treatment includes therapeutic services such as applied behavior analysis therapy.
Indiana
Indiana’s autism insurance bill, IC-27-8-14.2, was enacted in 2001 and covers autism-related treatment, such as ABA therapy, prescribed by a qualified physician as part of a comprehensive treatment plan.
Kentucky
Kentucky’s House Bill 159 was enacted in 2010. In 2018, it was amended to remove age and dollar caps on ABA insurance coverage (House Bill 218). Coverage in Kentucky is extensive and includes the following: autism diagnostic support, ABA therapy, medical, pharmacy, and psychiatric care, as well as speech, occupational, and physical therapy.
Minnesota
Minnesota’s autism insurance bill, HF 1233, was enacted in 2013 and covers individuals with autism under 18 years of age. Under this law, young people with autism can receive diagnostic support and assessment services, early intensive behavioral interventions like ABA therapy, and therapeutic services like speech therapy.
Missouri
Minnesota’s autism insurance bill, HF 1233, was enacted in 2013 and covers individuals with autism under 18 years of age. Under this law, young people with autism can receive diagnostic support and assessment services, early intensive behavioral interventions like ABA therapy, and therapeutic services like speech therapy.
Nevada
In Nevada, individuals under the age of 18 can receive autism screening and diagnosis services, ABA therapy, psychiatric care, and speech, occupational, and physical therapy under Assembly Bill 162.
North Carolina
North Carolina’s autism insurance bill, Senate Bill 676, was enacted in 2015 and covers behavioral therapy and other therapeutic services for individuals with autism under 19 years old.
Ohio
Ohio’s autism insurance bill, House Bill 463 (Sec. 1751.84), was enacted in 2017 and covers speech and occupational therapy, ABA therapy, and outpatient mental health services for people with autism under age 21.
Pennsylvania
House Bill 1150 in Pennsylvania became effective in 2009. It covers diagnostic support, ABA therapy, pharmacy care, psychiatric care, and other therapeutic services for individuals with autism under 21 years old.
Texas
SB 946, the autism insurance bill in Texas, requires insurance companies to cover all generally recognized autism-related services prescribed by the child’s primary care physician (PCP) so long as the autism diagnosis was made before the child’s tenth birthday.
FAQs about insurance
View all FAQs
Does insurance cover ABA therapy?
Yes. Most health insurance plans cover ABA therapy, and we are proud to be in-network with the largest insurers in our service areas. At ABC, our insurance specialists handle the details for you. We verify your child’s coverage, complete any necessary pre-authorization paperwork, and directly bill the insurance company.
Can I just make a copay for ABA therapy like I do at the doctor’s office?
If your plan requires a copay or coinsurance, you can pay securely through our online patient portal. During the admissions process, we provide a fee schedule and an estimate of your anticipated out-of-pocket costs for ABA therapy.
How many hours of ABA therapy does insurance cover?
The number of ABA therapy hours your child needs depends on their age, developmental level, and individualized goals. A Board Certified Behavior Analyst (BCBA) and other clinicians perform a thorough assessment of your child’s needs and your family’s goals before recommending the right number of hours. Our insurance specialists then confirm how many of those hours are covered by your plan and help you understand any out-of-pocket costs.
What if my insurance doesn’t cover all of the recommended therapy hours?
If your insurance company approves fewer hours than recommended, our team will appeal on your behalf. We also discuss financial assistance options to ensure your child gets as much support as possible.
Do I have to reach my deductible before insurance covers ABA therapy?
In most cases, yes. Families are responsible for their deductible and any applicable copays or coinsurance until their maximum out-of-pocket (MOOP) is met. After that point, insurance typically covers 100% of remaining ABA therapy costs for the year.
Prepare them for a bright future with ABA therapy
Start ABA therapy today. Our online interest form helps us match you with a center near you. We will be in touch soon.
