Does MultiPlan Cover ABA Therapy?

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Does MultiPlan Cover ABA Therapy?

Health insurance plans use MultiPlan, a network of medical centers and practitioners, including local therapists and doctors specializing in mental health, to provide members with access to a greater selection of healthcare and discounted treatments. Because of this, MultiPlan does not oversee benefit plans or offer insurance.

Health insurance plans that are part of the MultiPlan network may cover the cost of Applied Behavior Analysis therapy (ABA). Coverage for mental health treatment in this network depends on your specific plan. In addition, you may need to meet specific requirements to qualify for Multiplan ABA therapy coverage.

ABA therapy is founded on the science of learning and behavior. This evidence based therapy utilizes what we know about how behavior works and applies that to actual circumstances. The objective is to increase helpful behaviors while reducing negative or learning-impairing behaviors.¹ Primarily used for autism therapy and focused on a behavioral approach, ABA therapy teaches actions that will make patients’ lives safer and more satisfying.²

Licensed clinicians help autistic individuals develop abilities such as:

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

How to Verify MultiPlan ABA Therapy Insurance Coverage

The best way to learn the details of your MultiPlan behavioral health benefits is to contact your insurance provider directly.

While Athena Care does not offer ABA therapy, we do provide comprehensive mental and behavioral health services in Tennessee, including autism assessment, psychotherapy and counseling, medication management, TMS, Spravato and more. We’re also in-network with most major insurance companies. Contact us below, and one of our care coordinators will help you navigate your insurance coverage and get the care you need.

Requirements, Eligibility & Process for Multiplan ABA Coverage

Because MultiPlan is a network of medical professionals and facilities, your specific health insurance plan under the MultiPlan network will have varying requirements for ABA therapy MultiPlan coverage. The best way to find out what your particular health insurance plan requires is to reach out to one of our multiple behavioral health clinics in Tennessee. We’re open Monday through Friday, 7 am – 6 pm.

In most cases, if not all, health insurance companies require a diagnosis of Autism Spectrum Disorder (ASD) from a licensed professional. Typically, an ABA assessment is deemed medically necessary when:

• The patient has been diagnosed with ASD following the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. This diagnosis came from a healthcare provider licensed to practice independently and whose licensure board believes diagnostics are within their scope of practice.

ABA is typically considered experimental, investigative, or untested for all non-ASD-related causes. Services primarily educational, vocational, or connected to work or academic achievement are separated from those that are medically necessary. You can receive ABA therapy without an autism diagnosis but expect to pay out of pocket costs. Most insurance companies won’t cover the cost.

How Much Does ABA Therapy Cost Without Insurance?

The average cost of ABA therapy is $120 per hour. Some require up to 40 hours of ABA therapy each week to reach their full potential. This amounts to $4,800 per week or $249,600 per year without health insurance benefits.³

Forbes estimates the annual cost of ABA treatment without coverage is about $17,000. However, it might range from $45,000 to $100,000 annually for some.⁴

Furthermore, the Centers for Disease Control and Prevention (CDC) projects that average annual medical costs for a child with one of the autism spectrum disorders are $4,110 to $6,200 higher than for children without the condition.⁵