Does TRICARE Cover Autism Testing & Treatment?

Does TRICARE Cover Autism Testing & Treatment?

Yes, TRICARE insurance may be able to cover autism testing and treatment in Tennessee, depending on your insurance plan. However, certain services require a referral or prescription prior to coverage.¹

The following people are eligible for TRICARE coverage:²

• Active-Duty Service Members and their families
  • National Guard/Reserve members
  • Army National Guard
  • Army Reserve
  • Navy Reserve
  • Marine Corps Reserve
  • Air National Guard
  • Air Force Reserve
  • U.S. Coast Guard Reserve
• Survivors
• Former spouses
• Medal of Honor recipients and their families
• Others registered in the Defense Enrollment Eligibility Reporting System (DEERS)

Jump to Section

• Does TRICARE Cover Autism Testing & Treatment?
• How to Verify TRICARE Autism Coverage
• What is Autism?
• Is Autism Testing Covered by TRICARE?
• Are Autism Treatments & Medications Covered by TRICARE?
• How To Find TRICARE Autism Testing & Treatment Clinics Near Me?
• How Much Does Autism Testing & Treatment Cost Without Insurance?

How to Verify TRICARE Autism Coverage

To determine if you’re eligible for TRICARE coverage for autism testing and treatment, call your insurance company or contact us below. Athena Care provides 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.

What is Autism?

Autism Spectrum Disorder (ASD) is a developmental disorder that can cause substantial social, communication, and behavioral challenges. People with autism can have various cognitive, reasoning, and problem-solving abilities and difficulties, ranging from gifted to the severely impaired.³

Types of Autism

There are five types of Autism:⁴

• Asperger’s Syndrome: Most people with this disorder are intelligent and have excellent verbal skills, but social communication is challenging.
• Rett Syndrome: Rett’s Syndrome primarily affects young girls. Symptoms include difficulty with social communication and the impaired ability to use one’s hands.
• Childhood Disintegrative Disorder (CDD): Children who had previously appeared to be developing normally, were socially engaging, talked and made eye contact, have suddenly stopped being themselves and shut down.
• Kanner’s Syndrome: Communication and difficulty understanding others, little or no eye contact, and hypersensitivity to stimuli (smell, light, noise, taste, or touch) are all possible symptoms.
• Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS): Children with this type of autism may have delayed developmental milestones like speaking or walking, and they frequently fall behind other children who are on track to meet their developmental goals.

Signs & Symptoms of Autism

Although there is typically nothing about people with autism that distinguishes them from others in terms of appearance, they may communicate, engage, conduct, and learn in unique ways. The signs of autism spectrum disorder include but are not limited to the following:⁵

• Difficulty developing social communication and interpersonal skills
  • Example – Does not respond to name by nine months of age
• Restricted or repetitive interests or behaviors
  • Example – Becomes upset by minor changes in routine
• Delayed cognitive, learning, language, and movement skills
• Hyperactive, impulsive, and/or inattentive
• Epilepsy or seizures
• Unusual sleeping and eating patterns
• Gastrointestinal issues (i.e., constipation)
• Mood swings or emotional reactions that are out of the ordinary
• Anxiety, tension, or excessive worry
• Fearlessness or greater than expected fear

Is Autism Testing Covered by TRICARE?

Yes, TRICARE coverage for autism treatment is available. TRICARE covers many tests and assessments to help diagnose a patient and develop a treatment plan.⁶

Because there is no medical test for autism spectrum disorder, such as a blood test, diagnosing the illness can be difficult. So instead, doctors examine the child’s developmental history and behavior to make a diagnosis.

Developmental monitoring looks at how your child grows and evolves and whether or not they meet developmental milestones in areas like playing, learning, speaking, acting, and moving. Parents, grandparents, early childhood professionals, and other caregivers can all keep track of a child’s development.

Developmental screening is a more thorough examination of your child’s development. Your child will take a test, or you will be asked to complete a questionnaire about your child. A doctor or nurse and other specialists from the healthcare, community, or educational sectors can perform developmental screening.

Doctors can detect autism as early as 18 months. As a result, a diagnosis by an experienced professional before the age of two is reliable. Many, on the other hand, do not receive a clear diagnosis until they are much older.⁷

Are Autism Treatments & Medications Covered by TRICARE?

Yes, TRICARE autism coverage includes treatments, as well as prescription medications.

There is currently no medication specifically for autism or all of its symptoms. However, some drugs can aid in treating its symptoms, particularly certain behaviors.

According to research, medication is most effective when combined with evidence-based psychotherapy, such as Applied Behavioral Analysis (ABA). ABA applies behavioral principles to everyday settings, such as positive reinforcement. The goal is to increase or decrease specific habits. ABA services can aid in developing a variety of abilities, including communication, self-help, and play. It can also help in reducing aggressive or self-injuring behaviors.

How To Find TRICARE Autism Testing & Treatment Clinics Near Me?

With Athena Care, gaining access to Autism therapy clinics in Tennessee has never been easier. A care coordinator can assist you with any questions or concerns about TRICARE and autism coverage at one of our multiple locations throughout Tennessee, open Monday through Friday, 7:00 a.m. to 6:00 p.m.

When choosing autism clinicians or care providers, it’s important to keep the following in mind:

• Education, training, license, and years of experience
• Specialties and services offered
• Treatment methods and philosophies
• Insurance companies they work with
• Office hours
• Pricing
• Session length

Here, you’ll find a list of practitioners organized by city and information about their backgrounds and specialties. Don’t hesitate to ask lots of questions.

How Much Does Autism Testing & Treatment Cost Without Insurance?

The following are average costs, though they may vary by location and other variables and may not reflect the actual cost of what you’ll pay for testing or treatment.

Doctor’s visits can range from a few hundred dollars to more than $2,700. In the United States, the typical cost of psychotherapy ranges from $100 to $200⁷ a session, dependent upon the state and the length of the session.

The cost of a supply of 30 risperidone (a drug that treats signs of irritability associated with autism in children) 1 mg oral tablets is roughly $18.⁸ Furthermore, the average price of Applied Behavior Analysis (ABA) is $120 an hour. Some children require up to 40 hours of ABA therapy every week to reach their full potential, which amounts to $4,800 per week or $249,600 per year.⁹

Sources

1. TRICARE. “Autism Spectrum Disorder.” TRICARE, Department of Defense (DoD), www.tricare.mil/CoveredServices/IsItCovered/AutismSpectrumDisorder. Accessed 7 June 2022.
2. TRICARE. “Eligibility.” TRICARE, Department of Defense (DoD), www.tricare.mil/Plans/Eligibility. Accessed 7 June 2022.
3. “What is Autism Spectrum Disorder?” U.S. Department of Health & Human Services, 2020, https://www.cdc.gov/ncbddd/autism/facts.html
4. Martino, Roxane. “What Are the 5 Different Types of Autism? Integrity, Inc, 23 July 2019, www.integrityinc.org/what-are-the-5-different-types-of-autism.
5. “Signs and Symptoms of Autism Spectrum Disorders.” U.S. Department of Health & Human Services, 2021, https://www.cdc.gov/ncbddd/autism/signs.html
6. TRICARE. “Mental Health Therapeutic Services.” TRICARE, Department of Defense (DoD), www.tricare.mil/CoveredServices/IsItCovered/MentalHealthTherapeuticServices. Accessed 7 June 2022.
7. “Screening and Diagnosis of Autism Spectrum Disorder.” U.S. Department of Health & Human Services, 2020,  https://www.cdc.gov/ncbddd/autism/screening.html
8. “Risperidone Prices, Coupons and Patient Assistance Programs.” IBM Watson Micromedex, Cerner Multum™, ASHP, 2022, https://www.drugs.com/price-guide/risperidone
9. Tatom, Carol RBT. Autism Parenting Magazine, 2022, “How Much Does ABA Therapy for Autism Cost?” https://www.autismparentingmagazine.com/aba-therapy-autism-cost/