Sacramento ABA Therapy: Insurance and Funding
In California, the legislation mandates that health insurance plans must cover autism-related treatments, as specified by Senate Bill 946. This includes diagnostic assessments, behavioral interventions, habilitative and rehabilitative care (with extensions beyond 20 visits if deemed medically necessary), prescription medications (if covered by the plan), psychiatric and psychological care including family counseling, and evidence-based treatments like Applied Behavior Analysis (ABA) therapy.
Coverage requires treatments to be medically necessary and determined by a licensed healthcare provider, emphasizing that early intervention should support, not substitute, ASD-specific treatments.
- Assembly Bill 88 (2011): Serving as the cornerstone legislation in California, this law mandated that specific health insurance plans must include coverage for ASD diagnosis and treatment. This pivotal statute marked a crucial advancement in establishing insurance support for services related to autism.
- Senate Bill 946 (2012): This legislative update further broadened the scope of the original act by extending the age eligibility for coverage. Previously, benefits were restricted to children between two and five. With the passing of SB 946, this age range expanded to include children from two to ten, thereby broadening the demographic that could take advantage of these vital treatments.
Steps to secure funding for your child’s autism therapy:
- Obtain proper diagnosis.
An autism diagnosis involves having a licensed psychologist, pediatrician, neurologist, or other professional provide an official diagnosis of autism spectrum disorder or related diagnoses in which ABA is a recommended treatment. This is usually an insurance requirement to qualify for ABA therapy coverage. Potential diagnosing services in the area include Sacramento Valley Pediatric, Bridges of the Mind: Psychological Services Inc., and Healthy Mind Sacramento: Psychological Services Inc.
- Find an in-network provider.
Currently, Sacramento ABA is in network or in the process of contracting with the following carriers:
- Aetna
- Blue Cross B;ue Shield
- Tricare
We do not take Medicare or Medicaid.
- Understand your insurance policy.
Most insurance plans outline your deductible, copayment, or coinsurance, and out-of-pocket maximum – you can contact your insurance provider to get specific information about your plan. A deductible is the amount you pay for covered healthcare services before your insurance plan starts to pay.
Typically, that means at the beginning of the year, you will be responsible for the entire cost of the sessions until you reach the deductible amount.
Copayment or coinsurance is the portion of the cost of the session you will pay after you meet your deductible. Coinsurance is typically a percentage of the cost; copay is a fixed amount you pay per session or day. You will continue paying coinsurance or copay until you reach the out-of-pocket maximum.
You should contact your insurance provider directly for the most up-to-date information on whether or not your insurance covers ABA services. Sacramento ABA Therapy will assist you in understanding what your specific insurance plan will cover, along with any out-of-pocket expenses you might incur. Consult your treatment providers and insurance company directly for an accurate cost estimate.
- Don’t forget to consider the costs and financial planning.
The documentation from every session goes through several steps with the insurance company. They receive the request, review it, ask for additional information, and then determine the payment, including the portion paid by the client.
The entire process could take up to several months, which could lead to a large bill for several months of service.
We will help you estimate and monitor your costs in advance so you can manage your payments and ensure uninterrupted ABA therapy services.
