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Insurance covering ABA

Posted by on Jul. 16, 2013 at 6:57 AM
  • 12 Replies

What insurance do you have?  Does it cover ABA for your child?

by on Jul. 16, 2013 at 6:57 AM
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Replies (1-10):
Stephw1110
by Silver Member on Jul. 16, 2013 at 7:20 AM

We have Aetna through DH's job and yes they pay because it's state mandated.  But right now we are really fighting them because they deny every claim the first time.  We just started about a month ago so we're still working out the bugs. 

darbyakeep45
by Darby on Jul. 16, 2013 at 7:27 AM

Is it state mandated for your state or every state?  Just curious.

Quoting Stephw1110:

We have Aetna through DH's job and yes they pay because it's state mandated.  But right now we are really fighting them because they deny every claim the first time.  We just started about a month ago so we're still working out the bugs. 


Stephw1110
by Silver Member on Jul. 16, 2013 at 7:34 AM

Just our state.  Indiana mandates that private group insurance cover most therapies used for treatment of ASD.  Their loophole is if the company is self-funded (the company you work for actually pays the medical instead of having it through another company) they don't have to cover it.  Before DH's company was self-funded so they didn't pay anything.  We did appeal and they agreed to pay for feeding therapy with a speech therapist because well obviously feeding issues can lead to a medical problem.  Starting this year they switched over to Aetna which was a relief for us.  So far it's been a complete headache but hopefully soon it will get worked out. 

JTMOM422
by Platinum Member on Jul. 16, 2013 at 9:30 AM

We have Tricare Echo. Yes it covers ABA

darbyakeep45
by Darby on Jul. 17, 2013 at 5:33 AM

We have the same:)  Have you heard about all the new changes coming up?  BIG changes...UGH!

Quoting JTMOM422:

We have Tricare Echo. Yes it covers ABA


JTMOM422
by Platinum Member on Jul. 17, 2013 at 8:47 AM
NO what is happening? I got an email stating who can get ABA but nothing more. Can you tell me ?
Quoting darbyakeep45:

We have the same:)  Have you heard about all the new changes coming up?  BIG changes...UGH!

Quoting JTMOM422:

We have Tricare Echo. Yes it covers ABA


darbyakeep45
by Darby on Jul. 17, 2013 at 9:11 AM

Oh my goodness...I can't believe you don't know...I'm going to PM you right now:)

Quoting JTMOM422:

NO what is happening? I got an email stating who can get ABA but nothing more. Can you tell me ?
Quoting darbyakeep45:

We have the same:)  Have you heard about all the new changes coming up?  BIG changes...UGH!

Quoting JTMOM422:

We have Tricare Echo. Yes it covers ABA



emarin77
by Gold Member on Jul. 17, 2013 at 12:27 PM

Yes and I was surprized, United Health Care.  My son does not need this type of therapy though.  His psychologist didn't agree with it and so did I.

ineedcoffeemom
by Brittaney on Jul. 17, 2013 at 12:31 PM

We have Aetna but it's a Self - funded group plan so even though I live in a state that mandates insurance cover ABA, they can only say that for fully funded insurance.

KatyTylersMom
by on Jul. 17, 2013 at 2:14 PM

Whether an insurance plan covers ABA depends on if the state you live in has passed a law requiring that ABA therapy be covered.  Most (if not all) of these laws only apply to fully-funded plans and many employers trying to save money these days are going with "self-funded" plans where the employer pays the costs of many day-to-day medical expenses and the insurance company is only on the hook for major medical bills. 

If you live in a state where ABA is legally required to be covered and your company offers an HMO and PPO plan the HMO may cover ABA while the PPO may not.  If that is the case then you need to talk to your company's HR department and demand parity (they LOVE that word) between the two plans.  You should not have to choose worse insurance coverage to get ABA covered. 

And from what I hear TriCare is getting major cuts to ABA despite just having begun coverage?

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