Accessing Applied Behavior Analysis through Private Insurance

Recent advocacy efforts may have made it possible to access medically necessary Applied Behavior Analysis (ABA) through your private insurance.

Each insurance company has a different process for accessing benefits. To find out how to begin ABA therapy that has been prescribed for your child you can call Customer Services on the back of your insurance ID card and ask to speak with the Behavrial Health Department or Mental Health Department.

To find out if ABA is medically necessary for your child, and to access ABA benefits, you will need to visit your child’s doctor. A Developmental Pediatrician or Psychologist/Physiatrist may be more familiar with Applied Behavior Analysis as part of multi-disciplinary treatment than a General Physician.

To gain access to a benefit covered by your insurance the prescribing doctor may need to be an in-network contracted provider (or preferred provider). Call the Customer Service number on the back of your insurance membership card to be sure your child’s doctor is a preferred provider.

Your insurance may only approve a certain amount of appointments per year. If you believe the benefits are unreasonably capped, you have the right to appeal (if your child needs more than is approved). You can learn more about appeals at www.washingtonautismadvocacy.org

To find out if your insurance has begun to cover ABA or is the process visit;

http://www.washingtonautismadvocacy.org/updates/insurance/

If you are having trouble accessing ABA benefits for your child with autism, a Family Resource and Advocacy Coordinator with Washington Autism Alliance and Advocacy would be happy to assist you.