Steps to Navigating the Insurance Coverage Process of Your Child with Autism

Fortunately, coverage for the diagnosis and treatment of Autism Spectrum Disorder is mandatory in most insurance plans across all 50 states. Most plans purchased on and off the Health Insurance Marketplace or employer-provided group plans include autism benefits. Since each state has varying regulations regarding autism coverage, it’s important to research the rules for your state and explore the details of your insurance plan because certain policies do not include ASD benefits.

For those who cannot afford a plan or do not receive coverage through an employer, applying for Medicaid or researching lower-cost plan options on the Health Insurance Marketplace can be a great place to start. Whether you are fully insured, partially covered, or have no insurance at all, you can reach out to our autism services in Philadelphia or our other service areas for assistance with applying for a plan, understanding your benefits, and even negotiating with the insurers for a beneficial policy on your behalf.

Learn About Your Plan’s Benefits

If you are currently insured through an employer, individual plan, or government support plan, you can contact the insurer directly or read through your insurance documents to learn more about your specific autism benefits. When asking about your specific ASD-related benefits, your insurance provider must share detailed information about the types of services available to you. Ask about important details like:

  • Autism Diagnosis & Assessment Coverage: Before receiving coverage for your child with autism, a licensed physician will provide a diagnosis and pre-authorization for care eligibility.
  • Applied Behavior Analysis (ABA) Services: Since ABA therapy is considered a habilitative service, many plans cover this type of therapy. Your plan may also include support for related services like speech therapy, occupational therapy, and caregiver support as it relates to the ASD diagnosis and treatment plan.
  • Network of Care & Costs: Many plans will only provide full or partial payments for therapy-related services if you seek support within their “network” of providers. Be sure to ask the specific ABA providers you are working with if they are within your plan’s network. Also remember to ask about the costs you will be responsible for, such as your copay, premium, and deductible, because these factors will determine if you can afford the care your child needs to succeed.

Make the Most of Your Plan

Many plans provide complete coverage, amazing benefits, and incredibly low-cost options for receiving the ongoing support you need. Finding those great plans and understanding what’s available to you can be challenging! Our helpful autism services in Lehigh Valley, PA, along with our other northeast locations, work hard to make quality and accessible ABA therapy a reality, and we will gladly walk you through the entire process.

For guidance with your search, or if you have any questions about the types of covered services our caring ABA professionals provide, get in touch with our knowledgeable team for free resources and other helpful insurance tips today!

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