Insurance and ABA Services: What You Need to Know
To those of you who are raising a child or children with autism, you understand just how useful Applied Behavioral Analysis (ABA) services can be. A concern, however, with so many of you is the struggle with finding insurance that actually covers ABA therapy costs. So that you have some peace of mind, the following will provide the detailed information that you need about health insurance laws in addition to how you can find the most appropriate plan for your child’s needs.
ABA Insurance Laws: Understanding All of the Facts
Before we get into insurance talk, let us uncover some of the basics about ABA so that you understand more about what may or may not be covered in a health plan. As previously stated, ABA is an acronym for Applied Behavioral Analysis. It is an autism treatment plan meant to bring about positive change in behavior. This is usually delivered in any setting such as the home, a clinic, and even in school. As such, any health insurance plan that specifies it covers the treatment of autism generally covers ABA services.
As our ABA home care and additional services are offered in New York and New Jersey, it’s important to examine laws specific to those states.
New York Insurance Coverage
The state of New York passed the Autism Insurance Reform Law back in 2012. This law required that state-regulated health insurance plans must provide the necessary medical coverage for the diagnosing, screening, and treating of individuals with autism disorder.
There is no age limit that comes with this law, which will be useful in the continued treatment of patients well beyond the teenage years, and the coverage has a maximum benefit cap of $45,000 a year. In order for you to receive coverage, any practitioner you see must be licensed through the New York State Education Department (NYSED).
New Jersey Insurance Coverage
In New Jersey, there is an Early Intervention System in place that helps with the coverage of autism disorder. However, it only applies to specific insurers and health benefit plans in the state. It covers screening and diagnosing of autism disorder, and once the disorder has been diagnosed, coverage will be provided for a treatment plan. The treatment plan should include physical therapy, occupational therapy, and speech therapy.
According to health insurance laws for the treatment of autism in New Jersey, there are no coverage or visitation limits. There is an age limit though as the law only applies to individuals who are 21 years old or younger. The practitioner of your choice has to be a board-certified behavior analyst (BCBA®) or they must be supervised by one.
Choosing an Insurance Plan
Knowing that you can find health insurance plans that can cover ABA services is a huge relief to many concerned parents. Nonetheless, settling on any one health insurance plan, and probably should, take time and careful consideration. You want to be sure that you find the plan that will best benefit your child. There are some steps you can take before you buy a health insurance plan for ABA services, an effective treatment for children on the spectrum.
Individual or Family Plans
As you probably are well-aware of, there are individual and family health care plans to choose from. You can view them both in order to decide which one will work out better for your family. In many cases, parents elect to choose family plans if they are available. It allows them to focus on just one course of action rather than finding multiple plans for themselves and their child.
No matter which way you decide to go, you can visit the Health Marketplace to sign up during open enrollment between November 1st and December 15th.
Review the Plan
Once you have decided to investigate one heath plan, be sure that you take a good look at the plan’s outline. This will allow you to be certain that it actually covers services related to autism disorder such as ABA treatment. To repeat what was mentioned earlier, all state-regulated health insurance plans in New York offer coverage for autism disorder, but only specific health insurance plans in New Jersey provide that same kind of coverage.
Health insurance plans in general will differ when it comes to their in-network and out-of-network provider benefits. It can help you out more to find a health insurance plan that not only covers ABA-related services, but also offers both of the network benefits rather than just one or the other. By offering you both, you are given a wider range of provider options to choose from so that you will not have to simply settle for just any ABA provider.
Weigh Your Options
With the health insurance laws in place in New York and New Jersey, you do have a good deal of options that you can choose from when selecting a health plan for your child’s ABA treatment. Because of this, it is important that you study each plan with awareness and even compare a few of them in order to find the proper one that will benefit your child the most in the long run.
To finalize things, the cost of covering treatment for autism disorder can be difficult, so it is crucial to find the right health plan for all of the insurance-accepted ABA therapy services available to your child. Both the states of New York and New Jersey offer you a certain amount of choice in the matter so that you are not forced to select from too narrow of a pool of health insurance providers.
Even so, this is not something that you wish to dive head-first into. Take some time and view the details of each plan accordingly to ensure that the plan will provide the right amount of coverage your child needs. This will make certain that your child receives the best ABA care as possible.