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Open Enrollment 2022: Parent Guide for ABA Therapy Coverage

October 7, 2021
By: Behavioral Innovations
Health Insurance, ABA Therapy Covered by Insurance

For most states, the Open Enrollment period starts on November 1, 2021, and runs through January 15th, 2022. During this limited period, families can sign up for a new health insurance plan or change to a different plan. This is the right time to make sure that ABA services continue uninterrupted in the upcoming year and are covered under the new insurance plan.

Autism Costs According to CDC     

If you have a child with an autism diagnosis and are worried about the cost of ABA therapy or have insurance that currently does not cover services, open enrollment is the perfect time to make the switch to an insurance plan that works for your family.

New to the Insurance Process? Here are some common Insurance Terms you should know.

If you are looking for the best insurance option to cover your child’s ABA therapy, it is important to know some frequently used insurance terms as these can impact your overall costs.

  Common Insurance Terms

Here’s a glossary of more health insurance definitions by Healthcare.gov.

Making changes to your current plan through your company? Make sure ABA therapy is covered.

Coverage for ABA therapy can vary from plan to plan. It is important to understand your benefits before you make any changes to your current plan.

First and foremost, you need to know if your company’s health plan is self-funded or fully insured. The biggest difference between the two is that self-funded plans fall under federal law and fully funded plans fall under the state mandate. Since there is no federal mandate covering ABA services, it is entirely at the employer’s discretion if they choose to include services in self-funded plans.

Reach out to your HR department to confirm if ABA therapy is included in the plan your company offers.

How to choose the best coverage for ABA therapy? 3 things to consider when selecting a plan!

  • Categories: There are typically 4 categories of a health insurance plan based on coverage and shared costs - Bronze, Silver, Gold, and Platinum.
  • Total Cost: It is important to keep in mind your monthly insurance bill (or premium), out-of-pocket expenses, and deductible to get a full view of your total cost.
  • Plan Types: There are various types of plans that may limit or allow you to see out-of-network providers. The most common plan types are HMO, PPO, POS, and EPO.

What are some of the insurance providers we are in-network with?

At Behavioral Innovations, we accept most major insurance plans to meet your needs. Here are some of the major insurance providers we are in-network with. For more details and FAQs about insurance, visit our website. If you don’t see your insurance provider listed, please contact us at 855.782.7822 to see if we are in-network with your provider or discuss additional options.

Autism Coverage by State, Autism Insurance

Do you have Medicaid in Texas? You have options! 

Behavioral Innovations has been a strong advocate for the inclusion of ABA services as a covered benefit for those with Medicaid. Autism support groups and providers like Behavioral Innovations continue to advocate for The Human Services Commission (HHSC) to re-evaluate their proposed implementation plan with reasonable rates that will support coverage. Once an acceptable funding plan is in place, we will apply to become credentialed with Texas State Medicaid and begin providing services.

For families currently on Medicaid and needing to start services soon, you have the option of receiving ABA services through a Single Child Insurance Policy. These are low-cost policies specifically dedicated to children with special needs and are customized to cover specific therapy options. Insurance companies often negotiate individual contracts to provide reimbursement for applied behavior analysis (ABA) services by out-of-network providers. Below are 2 insurance brokers that specialize in helping families obtain low-cost coverage for children with special needs.

Jason Farrell
512.826.6287
farrellfinancial@gmail.com

Justin Boulet
281.493.6862
jboulet@hipson.com

How to Get Started

Below are some questions to ask when inquiring about insurance plans and ABA coverage.

• Is ABA covered by insurance as a benefit for my child?

• Are there certain criteria (e.g., autism diagnosis) that need to be met for coverage?

• What is my premium, copay/coinsurance, deductible, and out-of-pocket?

• Is there a benefit maximum for ABA service?

• Which ABA therapy providers are in-network?

Next Steps

The insurance journey can be daunting. We understand. This is why our Client Intake Advocates are trained to answer all your questions. We have been serving kids with autism for over 20 years and in that time, have worked with numerous big and small insurance companies to present parents with the best possible plan moving forward. Contact our experienced team to find the insurance plan that works for your family.

Important: If you change your plan, inform your therapy provider as soon as possible to update records.

Contact Us
Email: admissions@bi-aba.com
Phone: 855.782.7822