When you received your child’s diagnosis, you most likely received a few brochures for autism centers. As you begin researching, you may have wondered how your insurance can cover your ABA therapy visits. Knowing how to navigate your insurance coverage is important to get the best support for your child. Here are a few things you need to know about ABA therapy and insurance.

Does Insurance Cover ABA Therapy?

The good news is that your insurance most likely covers autism treatment. However, your policy details can vary between states and your provider. When you’re searching for autism treatment coverage, you may see two options: self-funded plans or fully insured plans.

Self-funded plans must comply with federal requirements, and your employer will decide what they cover. On the other hand, fully insured plans coincide with state laws, and the insurance company will determine what they cover. You must ask about coverage in detail so that you can best support your child.

North Carolina State-Regulated Insurance Coverage Details

If you’re a resident of North Carolina, you must be familiar with the state’s autism insurance bill, SB 676. Notably, this bill has a cap on ABA treatment at $40,000 annually and is for individuals under 19.

This autism insurance law applies to the following:

• Individual grandfathered plans
• Fully insured large group plans
• Fully insured small group grandfather plans

This state law also covers the following services:

• Pharmacy care
• Physical therapy
• Occupational therapy
• Speech therapy
• Adaptative Behavior Treatment
• Psychiatric care

We Will Advocate for You

Our team at HANDS will work diligently with your insurance company to secure treatment for your child. We will discuss the details of your benefits and eligibility for ABA treatments and other perks. Our team will also ask about out-of-pocket amounts, authorization, billing, and contracting procedures.

HANDS proudly works closely with the following providers:

• Blue Cross Blue Shield
• NC Medicaid
• Alliance Health
• Cigna
• United Healthcare
• Cardinal Innovations Healthcare

At HANDS, we’re always looking forward to meeting new families and enriching our learners every step of the way. We hope our quick guide to ABA therapy and insurance answers all of your questions. From hands-on therapy sessions to parent support, our team works hard to ensure you and your child have the necessary tools throughout this journey. For more information on our ABA therapy services, browse our website and contact us today.