Insurance Coverage for ABA

Under current law, many state-regulated health plans are required to cover the diagnosis and treatment of autism, including behavioral health treatment, such as Applied Behavior Analysis (ABA), as well as speech, occupational and physical therapy. Companies with self-funded insurance plans are not required to provide this coverage; however, you may ask your company’s Human Resources Department to provide this coverage. Please note that services must be prescribed by a licensed physician or psychologist to be eligible for insurance reimbursement.

If CARE is not a participating provider with your insurance carrier, we will collect the fee for services up front and provide you with detailed treatment records you may submit to your insurance for reimbursement (upon request).

How do I know if my insurance will cover ABA services?

We are a full-service agency and provide assistance with the following details for our clients who are insurance by plans CARE participates in:

  • Pre-authorization for services
    Contact insurance provider to verify benefits and complete the initial paperwork.
  • Re-authorization for services
    Provision of comprehensive assessment, progress and treatment program information to your insurance company for extension of services through required re-authorizations.
  • Billing claims and submissions
    Completion of billing and insurance claim submission.
  • Correcting denied or unpaid claims
    Correction of denied, unpaid or incorrectly paid claims.

If you have questions about funding, we can help guide you through the process of determining your child’s eligibility for ABA services under your health insurance plan. Please download, complete and submit the CARE Insurance Eligibility form.  Contact us with your questions – we’re here to help!