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Does Insurance Cover ABA Therapy for Autism?

Does Insurance Cover ABA Therapy for Autism?

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Does Insurance Cover Applied Behavior Analysis (ABA) Therapy?

Yes, most insurance companies cover the cost of autism treatment, including ABA therapy. However, Applied Behavior Analysis insurance coverage varies between locations, providers, and plans. Therefore, what you pay in one area of Tennessee might not be the same for another area.

In the United States, you can choose between two types of plans. These are:

  • Self-funded plans: These plans abide by federal law, not state law. Ultimately, what is and isn’t covered is decided by your employer.
  • Fully Insured Plans: These plans abide by state laws. In this case, the insurance company decides what is and isn’t covered.

ABA therapy is founded on the science of learning and behavior. Typically, it is used to teach persons with Autism Spectrum Disorders (ASD) and other developmental disabilities actions that will make their life safer and more satisfying.1

Instead of preventing harmless self-stimulatory behavior (stims), ABA therapists focus on teaching necessary basic skills and stopping dangerous behaviors.

Licensed therapists help autistic individuals develop abilities like:

  • Language and communication skills
  • Social skills
  • Hygiene and self-care practices
  • Leisure and play abilities
  • Motor skills

How to Verify ABA Therapy Insurance Coverage

Athena Care is in-network with most major insurance plans and provides behavioral health services in Tennessee. Filling out our free and confidential online insurance verification form is the best method to determine your ABA therapy insurance coverage details.

Allow our highly qualified care coordinators to handle the hassles of contacting your insurance company for more information about ABA insurance coverage. A care coordinator will review your plan and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared and discussed is kept confidential.

Insurance may be able to help cover the cost of therapy. Find out if your insurance provider can help with the costs by filling in our confidential insurance verification form below.

Requirements, Eligibility & Process for ABA Insurance Coverage

Although benefits can vary, coverage for autism therapy is required by law in all 50 states. Your plan may also differ from one insurance company to another. Some insurance providers warmly welcome and completely provide ABA insurance coverage, while others are more limited in their insurance for ABA therapy.

According to Tennessee state law, contracts and plans that offer benefits for neurological illnesses must also provide health insurance benefits for treating autistic children under the age of 12.2

A professional diagnosis of Autism Spectrum Disorder and a thorough behavior assessment are typically required for ABA insurance coverage. In addition, before any ABA sessions begin, ensure all of the required paperwork has been submitted. Failure to do so could result in you having to foot the entire bill. Furthermore, find a behavioral health provider within your insurance network, which is almost always more affordable.

Insurance for behavioral health services is still subject to meeting out-of-pocket costs, like deductibles and copays.

How Much Does ABA Therapy Cost Without Insurance?

Forbes estimates the annual cost of ABA therapy, excluding insurance, is about $17,000. However, it might range from $45,000 to $100,000 each year for some children.3 In addition, the length of therapy can range from 20 to 40 hours per week.

According to the CDC, average annual medical costs for a child with ASD are $4,110 to $6,200 higher than for children without the condition.4

Thankfully, ABA therapy is far less expensive with insurance coverage.

Sources

  1. “Questions and Answers About ABA.” Autism Speaks, 11 Aug. 2021, www.autismspeaks.org/blog/questions-and-answers-about-aba.
  2. “Autism and Insurance Coverage State Laws.” National Conference of State Legislatures, 24 Aug. 2021, www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.
  3. Molko, Ronit. “What Is Covered? The Insurance Landscape for Autism Services.” Forbes, 18 Apr. 2019, www.forbes.com/sites/forbesbooksauthors/2019/04/18/what-is-covered-the-insurance-landscape-for-autism-services/?sh=133bbd3325c2.
  4. “Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC.” Centers for Disease Control and Prevention, 31 Mar. 2022, www.cdc.gov/ncbddd/autism/facts.html.

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155