What to Do When Your Insurance Changes: A Guide for ABA Families

If you’re a parent of a child receiving (or hoping to receive) ABA services, few things cause more anxiety than an insurance change. Maybe it’s a new job, open enrollment, a switch from Medicaid to private insurance, or a plan that suddenly “updated its benefits.” Whatever the reason, insurance changes can feel overwhelming and confusing.

The good news is that an insurance change doesn’t automatically put ABA services at risk. With some proactive steps and persistence, many families are able to continue care seamlessly or begin the process of starting services with ease.

Let’s walk through exactly what to do when your insurance changes, step by step.

Step-by-Step Guide to Navigating Insurance Changes

Before we dive into action steps, it’s important to know this: insurance changes are incredibly common in the ABA world. ABA providers deal with them every day. You are not the first family to go through this, and you won’t be the last.

The key is acting early, staying organized, and knowing what questions to ask.

Step 1: Get the Details of Your New Insurance Plan

As soon as you know your insurance is changing, gather the basics. Don’t rely on summaries or assumptions as plans can vary widely, even within the same insurance company.

Action Steps:

• Write down:
  • Insurance company name
  • Plan name
  • Member ID number
  • Group number
  • Customer service phone number
• Ask:
  • Is ABA therapy a covered benefit?
  • Is there an age limit for ABA?
  • Is there a diagnosis requirement (e.g., Autism Spectrum Disorder)?
  • Are there hour limits per month? Per year?

Pro Tip: If possible, ask for a Summary of Benefits in writing.

Step 2: Call Your ABA Provider Immediately

If your child is already receiving ABA, your provider should be one of the first calls you make. Even if you don’t have all the answers yet, looping them in early makes a big difference.

Action Steps:

• Tell them:
  • When the insurance change starts
  • The new insurance company and plan
• Ask:
  • Are you in-network with this plan?
  • If not, do you offer out-of-network options or single-case agreements?
  • What documentation will you need from me?

Many ABA providers can help verify benefits or guide you through next steps, but they can’t help if they don’t know an insurance change is coming.

Step 3: Check Network Status (This Matters More Than You Think)

One of the biggest reasons ABA services are interrupted is because a provider is suddenly out-of-network.

Action Steps:

• Call your insurance and ask:
  • Is my current ABA provider in-network?
  • If not, are there any in-network ABA providers accepting new clients?
• If your provider is out-of-network:
  • Ask about single-case agreements
  • Ask if your child qualifies for continuity of care (especially if services have already started)

Important: “In-network” lists are often outdated. Always double-check.

Step 4: Confirm Authorization Requirements

ABA almost always requires prior authorization, and those authorizations do not transfer automatically when insurance changes.

Action Steps:

• Ask your insurance:
  • What documentation is required for ABA authorization?
  • Do you need a new diagnostic report?
  • Is a new assessment required?
• Ask your provider:
  • Who submits the authorization?
  • How long does the process typically take?

Important: Expect this step to take time. Sometimes even weeks. Planning ahead helps prevent gaps.

Step 5: Gather (or Update) Key Documents

Insurance companies require a lot of paperwork. Having these documents ready can save weeks of back-and-forth. Your ABA provider may be able to help provide the necessary documents but if you have access to these documents, that is always a good idea as you are then able to help the process move forward more quickly.

Commonly Required Documents:

• Autism diagnostic evaluation (from a psychologist, developmental pediatrician, or neurologist)
• Most recent ABA assessment
• Treatment plan
• Prescription or referral for ABA (if required by your plan)

Action Steps:

• Request copies of all evaluations for your own records
• Ask providers to update reports if they’re outdated
• Keep digital and paper copies in one place

Pro Tip: Create an “Insurance & Therapy” folder either digitally or a paper file.

Step 6: If You’re New to ABA, Start Early

If you’re seeking ABA services for the first time, an insurance change can be a great opportunity but only if you start early.

Action Steps:

• Call multiple ABA providers (not just one)
• Ask:
  • Are you in-network with my insurance?
  • What is your current waitlist?
  • Do you help with insurance authorization?
• Get on waitlists even if insurance details aren’t finalized yet

Important Note: Unfortunately, waitlists are common. Starting early matters.

Step 7: Prepare for Temporary Gaps (Just in Case)

Even with perfect planning, there may be short gaps during transitions. If your services do happen to go on hold during an insurance change whether it’s due to delayed authorization approval, missing paperwork, or needing to find a new provider, having a plan for how to handle the gap in services can be helpful.

Action Steps:

• Ask your provider about temporary parent training
• Keep routines as consistent as possible at home
• Document behaviors and progress during the gap
• Implement strategies that you are already familiar with or that you learn about to support your child’s development and well-being

Pro Tip: Consistency at home can help bridge the gap while insurance catches up.

Step 8: Advocate (Politely, Persistently, and in Writing)

Insurance navigation often requires follow-up and frequent communication. As mentioned before, your ABA provider may be able to help you with this, but some insurance companies will need the parent to be more involved in the process of getting services approved. Additionally, there may be points in which you need to take the initiative and reach out to make sure things are moving forward. Don’t be afraid to ask questions, take notes, and make sure things are getting done.

Action Steps:

• Keep a log of:
  • Dates
  • Names of representatives
  • What was said
• Ask for decisions in writing
• If denied:
  • Ask why
  • Ask about the appeal process
  • Request clinical criteria used for the decision

Important Note: You are allowed to ask questions. You are allowed to appeal. You are allowed to push back.

Step 9: Don’t Forget About Secondary Insurance or Medicaid

If your child has secondary insurance (such as Medicaid), coordination of benefits can be tricky but helpful.

Action Steps:

• Ask both insurers:
  • Who is primary?
  • Who is secondary?
• Ask your provider:
  • Do you bill secondary insurance?
• Confirm whether Medicaid can cover copays or deductibles

Pro Tip: Taking this step can significantly reduce out-of-pocket costs.

Managing Insurance Changes for ABA

Insurance changes can be stressful, but they do not automatically mean ABA services will stop. With early action, clear communication, and consistent follow-up, many families are able to continue services or move forward with getting services started.

Focus on acting quickly, keeping records, and staying in contact with both your insurance company and your ABA provider. You don’t need to understand every detail of insurance to advocate effectively; asking questions and following up goes a long way.

If challenges arise, your ABA provider can help guide you through next steps. If you’re receiving services from Behavioral Innovations or would like to start ABA with us, feel free to reach out to us for support in navigating insurance changes for your child.