Your Guide to Getting Your ABA In-Home Therapy Covered

Think back to when your child was first diagnosed with acute autism. The feeling of hope in learning about ABA therapy from your child’s pediatrician, and the subsequent feeling of frustration in learning from your insurance company that the therapy is covered, but there are no providers in-network. That decision—to take the hit financially in order for your child to receive therapy—is the exact one a local veteran mother is making for her son. It’s what we do for our children. But families shouldn’t have to struggle so much in order for their child to receive the care they deserve.

Here at ABC Behavioral Therapy, we understand how life-changing ABA therapy can be. As one of the most popular and successful evidence-based aides for Autism, we’ve seen firsthand how applied behavior analysis (ABA) has improved social skills, communication, attention, focus, and so much more. But we also know how difficult the journey can be, which is why obtaining coverage for home-based autism services should be as stress-free as possible. We’ve rounded up all of our knowledge on statewide and nation-wide insurance laws to provide you with the knowledge and tools to make the best decision for your family.

A Breakdown of Illinois Autism Insurance Reform Law – Public Act 95

Established in 2008, Public Act 95 required many private insurers to start covering diagnostic assessment and treatment costs of up to $36,000/year for people with autism under the age of 21. Additionally, the law required that early intervention services be provided by certified specialists as cleared by the state—ensuring that your family would receive the right assistance from the right people.

Under this law, ABA was specifically listed as a covered form of rehabilitative care. It was a huge success for the autism community because it opened the door to families across the state that could not otherwise afford therapy. Act 95 not only mandated health insurance companies to comply with IL state law, it also required licensed clinicians to create and implement treatment plans, as opposed to the insurance companies.

We’re Here to Help

Unfortunately, there are still problems and setbacks facing families desperate for assistance. An exception to the law above are ‘self-funded’ policies, which are insurance plans whose terms and conditions are dictated by your employer. Even if ABA services are covered, many families find there are no providers in-network. So what then?

“It seems like we are constantly fighting with insurance companies to get coverage for these children’s therapy,” says Nina Koehler, Program Manager at Applied Behavioral Consulting.

That’s where ABC comes in. With such a beneficial approach to autism, we’re here to help you obtain coverage for ABA therapy.

• We have a working relationship with Blue Cross Blue Shield, Cigna, Humana, Aetna, and United Behavioral Health, and are always wiling to make a call on behalf of your child
• If you have an employer-sponsored insurance plan and you’re unsure if they cover ABA therapy, consider purchasing a singular plan from the Health Insurance Marketplace just for your child with autism
• ABA is an essential health benefit that’s required to be covered in Marketplace plans
• Private insurance will cover a significant portion of the cost of care. Deductibles typically paid out of pocket can be anywhere between $1,000-$5,000. After that, insurance usually covers 80% of the cost until the out-of-pocket maximum is reached. Then, services will be fully covered.

Still have questions? Please feel free to reach out to us. Navigating your insurance plan can be stressful and confusing, especially when it seems you aren’t receiving the individual attention you require. Parents are always the most dedicated advocates for their child, and we’re here to guide you from start to finish – from walking through your insurance plan to providing your child with the tools to help them succeed.