Insurance Trouble

Find Help for ABA Therapy Coverage

If you’re having trouble understanding how your insurance policy can contribute towards the costs of our therapy, this page has been designed to help. The good news is that in the vast majority of cases, insurers must contribute to the majority if not all of the costs for ABA therapy for your child.

What is the law on coverage of ABA therapy in Illinois?

The Illinois Autism Insurance Mandate (2008) states that all private insurance companies, state and federally mandated, are required to cover the diagnosis and treatment of autism in all persons under 21 for all group or individual insurance plans. The only exception is ‘self-funded’ policies.

So my health provider must cover your therapy?

Yes, they are required to by Illinois State law. The only exception is if your insurance is provided by your company with its own funds. If this is the case then you may not be covered.

What happens if my employer-sponsored health insurance plan does not cover ABA therapy?

If you are happy with your employer-sponsored insurance plan but concerned that it doesn’t cover ABA therapy, you can purchase a plan from the Health Insurance Marketplace only for your child with autism. This will be a child-only plan.

What will private insurance coverage include?

Insurance will cover the vast majority of the cost of the care. Deductible will typically be paid out of pocket and can range between $1,000 and $5,000. Once the deductible has been paid, insurance will typically cover 80% of the cost until the out-of-pocket maximum is met. At that point, services will be covered at 100% of the cost.

Does ABC have a working relationship with any insurers?

Absolutely we do. We have a working relationship with AetnaHumanaMagellanCignaFox Valley MedicineMagellanPresence Health CareBlue Cross Blue Shield, and United Behavioral Health (Optum). If you are covered by any of these providers, we can contact them on your behalf to arrange cover for your child.

We will discuss your insurance options in step four of our first steps process. We understand how important it is for parents to get the correct coverage, which is why we are able to work with insurers on your behalf to implement their coverage.

Get started with ABA therapy today!

Hopefully, this page has eased your concerns surrounding insurance and pointed you in the right direction. If you are ready to move ahead with insurance, start by reading our first steps program. This is the onboarding process we use with all new clients and it will help us to better understand you and your child’s circumstances.

Included in this, as stated above, is a discussion about your insurance options. So even if you are still unsure, we can discuss your options in person and come to the right conclusion. Just give us a call at 630.402.6060, we are here to help.