Navigating Insurance and Hidden Costs of ABA Therapy Centers

You finally found an ABA therapy center you love, and your child is thriving. However, you might not be sure how to understand your insurance EOB, or maybe you received an unexpected billing statement that’s out of your budget.

Even the most hyper-conscious planners among us can feel confused about insurance, especially when it comes to what insurers cover in terms of ABA therapy. Together, we’ll navigate insurance commonalities as they pertain to ABA therapy and discuss avoiding hidden costs or denied claims.

Does My Insurance Cover ABA?

It’s not uncommon for parents and caretakers of children with autism to wait years for an official diagnosis. Once diagnosed, finding covered treatment options can lead to wait times, paperwork, and more questions. 

Luckily, in most cases, major insurance carriers cover ABA therapy. ABA facilities might also take Medicaid in states with ABA coverage. If the facility provides out-of-network services, families can seek reimbursement, depending on their particular insurance policy. 

ABA, or applied behavior analysis therapy, is often the first line of treatment for children with autism. This therapy addresses how cognitive factors and environmental stimuli affect a child’s behavior and is based on scientific research that supports its effectiveness. Therapy includes methods to modify behavior through changes in the environment (when possible) and through positive reinforcement.

How Much Is Covered?

The coverage amount your insurance carrier provides for ABA therapy varies depending on several factors, including whether or not you are required to use an in-network therapist, whether you have coinsurance, or whether or not you have a deductible. You might also owe a copay (as stipulated by your insurance policy).

One way to determine how much your carrier might cover is to contact them with the information about your preferred ABA therapy center to obtain a pre-approval letter for services. 

If your carrier won’t offer a pre-approval letter, seek out this information:

• Is an in-network provider required? If not, how much would the cost be for an out-of-network provider?
• Are all services offered by the therapy center included? (This can mean one-on-one therapy, group therapy, individual music/art therapy, full-day care, and more.) 
• What is the out-of-pocket deductible that applies to ABA therapy?
• Is there a yearly or quarterly limit on therapy?

Every insurance plan is different, and knowing what your benefits are can help reduce the likelihood of unexpected bills. 

Additional Costs of ABA Therapy

In addition to hourly costs, some ABA therapy centers offer different services, like all-day care, which may not be covered by insurance. For instance, if you enroll your child into a center that offers childcare in addition to ABA therapy, there could be additional costs not covered by your insurance. 

Other costs that may not be covered include:

• Food and snacks while your child is in therapy
• Extra sets of clothes and/or diapers
• Tools for learning, including art supplies, paints, musical instruments
• Emergency care, if it is needed

One technique to help prevent unexpected costs is to tour an ABA therapy facility and ask plenty of questions. If your child is only seeing a therapist, find out if they bill hourly and if there is a separate charge for use of the facility where your provider works. 

For a therapy center, investigate if a single session that involves more than one provider will be billed by both providers or just one. Some centers have multiple providers (speech therapists, occupational therapists, and other types of therapy.) that may work with your child. Learning how these services are billed can also help you get prior approval from your insurance carrier. 

Be Prepared

Board Certified Behavior Analysts (BCBAs) specialize in working with children with autism or neurological and developmental disorders. If you’re searching for a center with qualified personnel passionate about your child’s development, Stride Autism Centers can help.

At Stride, we understand that navigating insurance coverage for ABA therapy can be overwhelming. That’s why our dedicated team is here to help. Contacting us allows you to leave the insurance paperwork to us. We’ll collect all the necessary information, research your specific policy, and help you understand your coverage and potential costs. Our goal is to make the process as easy as possible for you, so you can focus on what matters most – supporting your child’s journey.

Brad Zelinger is the Founder and CEO of Stride Autism Centers.