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ABA Therapy Insurance Coverage

Insurance can be a big hurdle between your child and ABA therapy, and it shouldn't be. Circle Care works with most major plans across New Jersey, Georgia, North Carolina, and Maryland, including Medicaid in every state we serve. Tell us your plan, and we'll verify your benefits, request the authorization, and tell you what's covered before you commit to anything. You don't have to decode a benefits booklet on your own. That part is our job.

Call (877) 734-4536. We'll check your coverage right away.

Accepted insurance plans

Aetna
Aetna Better Health
Alliance Health
Ambetter
Amerigroup
AmeriHealth Caritas
Anthem
BCBS NC
CareFirst
CareSource
Carolina Complete Health
Cigna
GA Medicaid
Healthy Blue
Horizon
Horizon NJ Health
Katie Beckett Program
Maryland Medicaid
Medcost
Molina
NC Medicaid
Oscar
Oxford
Partners Health
Peach State Health Plan
PEHP
Regence
Trillium
UHC
UMR
UT Medicaid
Vaya Health
WellCare
Wellpoint

Unsure about your eligibility?

Don’t hesitate to give us a call.
Our team is here to help.

(877) 734-4536

Does insurance cover ABA therapy?

 

In almost every case, yes. ABA therapy is recognized as a medically necessary treatment for autism spectrum disorder, and every state has an autism insurance mandate of some kind. What changes from plan to plan is the detail: how many hours get approved, what you pay out of pocket, what paperwork is needed first, and how often the approval has to be renewed.

One important nuance: state mandates apply to state-regulated plans. If your employer is self-funded (many large employers are), your plan follows federal rules instead, and coverage is set by your employer. Most plans still cover ABA. We'll confirm which category yours falls into. Three things are usually needed before coverage begins:

 

  1. An autism diagnosis from a licensed provider, such as a psychologist, developmental pediatrician, or neurologist.
  2. A referral or prescription for ABA therapy.
  3. Prior authorization from your plan, based on an assessment completed by one of our BCBAs.

If your child hasn't been evaluated yet, that's not a dead end. We can connect you with trusted diagnostic providers in our network and walk you through what to ask for.

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Mom with son ABA therapy

Getting covered, step by step

If a request is denied, we don't hand it back to you. Our intake team handles appeals and peer-to-peer reviews as part of the service.

01

Diagnosis and referral

Your child needs an autism diagnosis and a referral for ABA. If you don't have either yet, tell us and we'll connect you with a diagnostic provider.

02

We verify your benefits

Send us your insurance card. We check whether we're in the network, what your plan requires, and what you'd pay, then explain it in plain language before you commit to anything.

03

Assessment and prior authorization

One of our BCBAs assesses your child and builds a treatment plan. We submit it to your plan and follow the authorization through, including any additional documentation they ask for.

04

Therapy begins

Once approved, we match your child with an RBT and BCBA and get started at our center, in your home, or at your child's daycare. We track your reauthorization dates so services never lapse.

What will ABA therapy actually cost you?

 

Without insurance, ABA therapy runs roughly $120 an hour nationally, which is out of reach for most families. With in-network coverage, what you pay is your plan's copay, coinsurance, or deductible, and on Medicaid, that's usually little or nothing. Because those numbers depend entirely on your specific policy, we give you an estimate in writing after we verify your benefits, before your child starts.

For a fuller breakdown of what ABA costs with and without coverage, read our guide to the cost of ABA therapy.

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Don't see your plan?

Plan networks change, and this page can't list every policy. If your insurer isn't shown, call us anyway. We may be in a network under a different plan name, your employer's plan may work differently from the standard version, or we may be able to arrange a single case agreement so your child can be seen. It takes one phone call to find out, and there's no cost to ask.

CHECK MY COVERAGE

We work with most major plans in the five states we serve. In New Jersey that includes Aetna, Aetna Better Health, AmeriHealth, Cigna, Horizon Blue Cross Blue Shield of New Jersey, Horizon NJ Health, Oscar, Oxford, UnitedHealthcare, UMR, and Wellpoint. In Georgia: Anthem, Ambetter, Amerigroup, CareSource, Georgia Medicaid, Peach State Health Plan, and Katie Beckett. We also work with Medicaid and major plans in North Carolina, Maryland, and Utah. Coverage may vary by plan, so call (877) 734-4536 and we'll verify yours.