For many families, the few months after a diagnosis are fraught. Parents can be given little to no resources at all, to get their child the help they need, or parents may be inundated with a landslide of resources. In either case, though, the end result may be the same: confusion and overwhelm. One of the most common sources of uncertainty is insurance coverage, and how it all works.
Before we dive in, let’s take a quick look at Applied Behavior Analysis (ABA), and why it is currently the most highly recommended intervention for people on the autism spectrum.
Applied Behavior Analysis: What Is It and Why Should Insurance Care?
ABA therapy is widely considered the gold standard intervention for autism spectrum disorder (ASD). In a session of ABA, a client can expect to work toward goals involving self-sufficiency, communication, hygiene, and safety. ABA is a behavioral therapy, which means that it focuses on encouraging healthy, functional behaviors while discouraging the pursuit or continuation of behaviors that are considered unhealthy, detrimental, or in some way problematic. Some of the concerns ABA addresses include:
- Sensory Issues/Aversions
- Self-Injurious Behavior
- Aggression
- Communication Difficulties
- Hygiene Difficulties
Although this is certainly not a comprehensive list, it can help families understand the value and purpose of ABA therapy for people on the autism spectrum.
Talking to Your Insurance Company
If you have not ever reached out to your insurance company and you are not sure how the process works, it is relatively simple: once you have a diagnosis and you have been given a referral for ABA from either your PCP or your diagnosing physician, you can reach out to your insurance company through the number on your insurance card. Be sure to ask about coverage as a whole, what the requirements for coverage may be, and what barriers exist to prevent coverage.
The ABA company you go with may also negotiate or discuss these questions during the intake process. Asking questions on your own, however, can help you develop more concrete expectations before actually enlisting an ABA professional, and can arm you with knowledge and precedent, should something go awry.
Evaluating Your Benefits
Not all insurance companies are created equal with regard to ABA coverage. Some coverage will be more extensive, and will cover sessions at 100%. Others will require a down payment for each individual session, and still others will offer conditional approval. As you talk to your insurance company, ask questions tailored to your unique situation to evaluate coverage, determine how likely ongoing coverage will be, and to determine the requirements for approval.
Making Sure You Are Ready for ABA Therapy
Selecting an ABA therapist is not quite as simple as looking up a name, reaching out, and getting the process started. Instead, there are a few supporting steps that must be put in place prior to enlisting an ABA therapist or therapy practice. These include:
- Make sure you have your diagnosis in hand. Insurance companies do not typically cover ABA therapy for conditions other than autism, so it is vital to make sure you have a formal diagnosis prior to requesting therapy. There are different types of diagnoses (a school diagnosis, for instance, versus a diagnosis from a qualified healthcare facility), so make sure that your diagnosis is from a reputable healthcare professional.
- Meet with a BCBA. Although many families work primarily with Registered Behavior Technicians, or people trained to administer ABA therapy, a Board Certified Behavior Analyst will be necessary to complete your intake and develop a treatment plan tailored to suit your family’s needs and you or your child’s goals.
- Verify coverage through your insurance. Although ABA is currently recognized as the gold standard for autism intervention and therapy, it is still important to make sure that services are covered by your insurance. Some treatment plans can require a significant time commitment, so verify coverage to ensure your goals are not hampered by financial difficulty.
- Stay on top of changes to insurance. Some insurance companies require periodic verification of autism. Others require updates to treatment plans on a regular basis. Still others will require verification that services are proving fruitful. Make sure you are aware of your insurance company’s requirements to prevent interruption to or loss of services.
ABA Health Insurance Coverage
Insurance can be confusing and overwhelming in the best of times. When looking for therapies for children with autism, it can be difficult to determine which therapies will or will not be covered by insurance, and which therapies should be prioritized. Learning more about your personal insurance coverage is the first step toward developing therapy literacy in the autism sphere, and can help you feel more empowered as you advocate for your child.
The Brook Center Therapy Solutions offers ABA therapy in White Bluff, TN and Waverly, TN. Contact us today to learn more!
