Does Insurance Cover ABA Therapy?
If you are a parent or guardian of a child with a behavioral disorder or mental health condition such as ASD (autism spectrum disorder), you may wonder, “Does insurance cover ABA therapy?” The question is a difficult one to answer, as it varies widely by state. In addition, it can depend on which ABA therapists you hope to use and what kind of insurance you have.
Is ABA covered by insurance? Read on for more information about how ABA works, who it is useful for, and what kind of financial help you can expect from insurance.
What Is ABA Therapy?
Applied behavior analysis, or ABA therapy, is a type of treatment that aims to help people stop disruptive or unwanted behaviors that interfere with socializing and relationships. Applied behavior analysis therapists work to anaylize behavior and then use that analysis to help improve behavior.
How Does ABA Therapy Work?
While there are many steps and techniques involved in applied behavior analysis, one of the most basic ideas is the antecedent-behavior-consequence sequence.
The antecedent is what precedes an action, or what makes it happen in the first place. The behavior is the action itself, or what the behavior therapist is trying to correct. The consequence is what follows the behavior. The consequence is often what determines if the behavior is repeated. For example:
Antecedent: Laurie wants a snack.
Behavior: Laurie cries and yells because she wants a snack.
Consequence: Laurie’s parents give her a snack.
This antecedent-behavior-consequence sequence makes it much more likely that Laurie will repeat the behavior (crying and yelling for a snack).
The behavior therapist alters the consequence in order to alter the behavior. For example:
Antecedent: Laurie wants a snack.
Behavior: Laurie cries and yells because she wants a snack.
Consequence: The behavior therapist does not give Laurie a snack.
The behavior of crying and yelling for a snack is now much less likely to be repeated.
Other Issues that ABA Can Help With
This is an over-simplification of how applied behavior analysis works as an autism treatment. However, ABA has been shown to be useful and helpful for those with various mental and behavioral conditions, not just as an autism treatment.
These include autism spectrum disorder, obsessive-compulsive disorder, post traumatic stress disorder, anger issues, and borderline personality disorder.
It is important to talk with professionals who can understand your unique situation and whether applied behavior analysis is a fit for you or your child, whether your child is on the autism spectrum or needs help with another issue other than autism spectrum disorder.
Education for ABA Therapists
There are 4 levels of education or certification for ABA professionals.
- There are RBTs, or registered behavior technicians, who need a 40-hour training in order to sit for the certification test.
- There are BCaBAs, or board certified assistant behavior analysts, who need a 4-year bachelor’s degree to sit for the certification exam.
- There is the BCBA, or board certified behavior analyst, who has a master’s degree.
- Then there is the BCBA-D designation, for those with a doctoral-level degree. An ABA clinic needs at least one board certified behavior analyst or BCBA-D in order to operate, as RBTs and BCaBAs must work under the direction of someone who’s been certified on a higher level. ABA therapists are highly qualified professionals, and for this reason and others, ABA therapy can be costly.
When your child gets a diagnosis of a mental health or developmental condition, such as being on the autism spectrum, it can often be very difficult to accept. Your life will be changed in many ways.
Once your child is diagnosed with autism spectrum disorder, you will need to get used to the fact that your child is on the autism spectrum. Your child will need to accept and understand, as they grow older, that they will always see the world differently from others. If you have other children, they will need to accept the autism spectrum disorder diagnosis as well.
You may need to re-organize your schedule around therapy sessions and other new demands on your time. You will need to decide if ABA therapy is the best choice for your child, and if so, what ABA therapist should you use? Autism spectrum disorder can bring a lot of complication to your life.
The Financial Question
On top of all of these emotional adjustments and decisions that need to be made, the financial question comes up. If ABA therapy is what your child needs, how are you going to pay for it? How much is this new financial burden going to add to the strain of everything else that’s been going on?
Is ABA Covered by Insurance?
That’s why it’s very important to look into insurance and what insurances cover ABA therapy. In fact, knowing whether or not ABA therapy is covered by insurance is essential to the financial plans of anyone who needs this service. If your child is on the autism spectrum or needs ABA for another reason, keep reading to find out more.
Is ABA Therapy Covered by Insurance?
There are 46 states with laws that require private insurers to provide ABA coverage, which makes it somewhat complex to find out what insurances cover ABA therapy. Each of these state laws about ABA therapy insurance are different. Some have maximums for the number of therapy hours per week, month or year. This is to prevent people from taking advantage of ABA coverage. However, these differences can make it complicated for parents or guardians who are trying to navigate the legal side of insurance coverage for ABA therapy.
Age Limit for Mandated Coverage
Other states have laws centered around an ABA therapy age limit for mandated coverage. In Virginia, for example, the law mandates coverage up to age 10. South Dakota also has an ABA therapy age limit: the coverage applies to people younger than 18. Some states do not require private insurers to provide ABA therapy insurance. For example, Idaho does not require private insurers to cover this service at all. In Wyoming, the state only has laws about ABA therapy insurance coverage for children who are enrolled in Medicaid.
Research the State Where You Live
This might seem complicated, but the important thing is to research what applies to the state where you live. If you live in a state where insurance is required to cover ABA, that answers your question immediately. If ABA therapy insurance coverage is not a requirement in the state where you live, you may have to keep researching and find out if your health insurance policy covers ABA therapy. The National Conference of State Legislatures website lists laws relating to coverage of autism spectrum treatment.
Private Health Insurance ABA Benefits
People with a private health insurance coverage plan find that there is a lot of variety in the level and quality of coverage for ABA therapy. The state laws on coverage amounts mean that a private insurer might contract with providers who deliver a poor quality of service. If the client gets to choose their ABA therapist, their allotted funds might run out if the therapist charges a high rate or the client frequently attends therapy.
Understand Your Insurance Company’s Policy
It’s important to look into your insurance company’s policy on ABA insurance coverage, if you have private insurance. While it may seem daunting to try to navigate the question of whether insurance covers ABA therapy, it’s worth it if you can get help with paying for your child’s ABA therapy or autism services. It can be different for each insurance company, or even depend on the autism services provider.
Public Health Insurance ABA Benefits
Public health insurance for children is part of the Centers for Medicare and Medicaid. Each state is given funds by the federal government and must use those funds by following a specific set of guidelines. Federal law requires that Medicaid pay for the screening, diagnosis and treatment of autism spectrum disorder, and ABA therapy is a recognized treatment for those on the autism spectrum. Medicaid might not cover ABA therapy for other conditions besides autism spectrum disorder. Each state administers its Medicaid program in a different way. Be sure to know how the system works in your state and how much help with the cost of ABA therapy you can expect from your state.
Cost of ABA Therapy
Without health insurance-mandated coverage of ABA therapy, a family could end up paying more than $21,000 per year, explains the National Conference of State Legislatures. Each state law about coverage for ABA therapy has different stipulations about the amount of coverage private insurers have to provide. The coverage level may change based on the child’s age. The level of coverage often wanes as a child gets older. For example, in Kansas, children can receive therapy costing up to $36,000 per year through age 7, but the annual cap for services between the ages of 8 and 19 is $27,000 per year.
Is ABA therapy covered by insurance? Research and understand the coverage levels in your state, and plan accordingly. That will help you to know which therapist to choose and how much you should plan to pay out of pocket, if any. Each insurance company might be different on this issue, so look into your insurance company and what their policy is on whether to cover mental health services or evaluation and assessment services.
A Word of Warning
Insurance laws change on a regular basis, and the amount of coverage or extent of the coverage could vary from one plan to another or one year to the next. The policyholder must make sure that a specific therapist is in their network of coverage or that they have not exceeded the allowed number of visits for ABA therapy during a benefit year. It’s important to keep track of this, as you could find yourself paying for more than what you planned for. Don’t assume that because insurance was mandatory for ABA therapy last year, it is mandatory this year. Continue to research in order to make sure you are able to cover what is needed for ABA therapy.
ABA Insurance Coverage: Planning for the Future
“Do insurance companies cover ABA therapy?” Understanding the answer to this question could help you, as a parent, caregiver, guardian or family, plan for your financial future. An autism diagnosis and decisions about ABA are deeply personal and often emotional issues. However, there is also a practical side that must be considered. Understanding how to plan for the future is an important step towards being able to support your child as they grow up. Keeping your financial situation in order is just one part of ensuring that your child gets the best care that is available.