A Word About Coverage Mandates
In the past, Applied Behavior Analysis (ABA) was not covered by most insurance plans. But with the ongoing proven success of ABA-based treatment, more and more insurance companies are covering such therapies in the plans they provide to employers. As a parent or guardian of a loved one with an ASD, you should double check your coverage for ABA-based treatment with both your human resources manager at work, as well as the customer service department at your insurance carrier. If your insurance plan does not have this coverage, you can and should encourage your employer to have these benefits included in your company’s plan.
Roughly half of the states in the U.S. currently mandate coverage for ABA therapy for certain health plans. More states will be doing the same in the months and years to come. The website AutismVotes.org will keep you apprised of all the states that mandate such coverage, as well as the emerging legislation in other states. If you reside in a state without mandated coverage, or if your plan is not subject to a state mandate, you can still advocate for behavioral health services coverage. Even if you have received a coverage denial or a claim rejection, you can appeal the decision by contacting your insurance company to learn how their appeal process works.
Looking ahead, the Patient Protection and Affordable Care Act (PPACA), which is a component of the national healthcare package being debated in Washington, will provide coverage for behavioral therapies, including ABA, for most insurance plans beginning in 2014. The debate in Congress continues, but hopefully this will be one of the provisions that survives the legislative process.