ABA Therapy 954 : Understanding Insurance Coverage for ABA Therapy!

ABA Therapy 954 recognizes the importance of insurance benefits for each patient to receive ABA therapies. Navigating the clinical and insurance requirements to qualify for and receive ABA services can feel overwhelming, but our admissions team is here to help. We work closely with families to verify insurance coverage, explain financial commitments, and create plans that minimize surprises on the journey to receiving ABA therapy. We accept most major insurance carriers; however, ABA benefit coverage may vary. Please contact us for assistance in understanding your individual coverage for behavioral conditions we support daily, such as Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), or Global Developmental Delay (GDD).

Do you Understand Your Insurance Coverage?

Outlined below is some important information about public and private insurance.

ABA Therapy Insurance Coverage?

Public & Private Insurance Converage.

Insurance Authorization Usually Takes One to Two Weeks
The cost of ABA therapy depends on your insurance coverage and how many treatment hours your child will need.
We can estimate coverage amounts once we complete a psychological evaluation and determine how many hours of ABA your child will require. Authorization timelines may vary depending on your insurance provider in Florida.
Deductibles, Copays, Coinsurance, and Out-of-Pocket Maximums
You may need to meet a deductible, which is the amount you pay for covered healthcare services before your insurance plan begins to pay.
Some insurance plans in Florida have coinsurance, meaning you would be responsible for a set percentage of a bill until you reach an out-of-pocket maximum, after which insurance would cover 100% of the services.
Additionally, copays in Florida vary by plan, but families may reach an out-of-pocket maximum, after which insurance will cover all services.
Exclusion of Benefits and Limitations
If you see the term “exclusion of benefits,” it means the insurance plan does not cover a particular service and will not authorize or reimburse it. If your plan in Florida does not cover ABA therapies/services, you may be able to work with your employer and/or insurance provider to add services.
In Florida, some policies have limitations on age ranges, hours/year, or total monetary caps (e.g., $30,000/year). We can help you identify these limitations so you can plan ahead.
Self-Managed Insurance Plans
Some employers in Florida offer self-managed insurance plans that require additional processes for service authorization. It is important to confirm the requirements directly with your employer.
These plans are often more flexible but may also include specific restrictions. We can assist you in reviewing your plan details to ensure you receive the necessary ABA coverage.
Public Insurance Coverage
In Florida, programs such as Medicaid may cover ABA services for children who meet the established requirements.
Medicaid in Florida requires that specific medical and financial criteria are met to qualify. We work with families to guide them through the application and approval process for Medicaid.
Plans Requiring Periodic Evaluations
Some plans in Florida require ongoing psychological evaluations to authorize ABA treatment. These evaluations help assess the progress of the therapy.
Additionally, regular reports from therapists are an essential part of meeting reauthorization requirements in the state. We can help you stay on top of these processes to avoid interruptions in services.
Geographic Restrictions
In Florida, some insurance plans limit coverage to providers within certain areas or approved networks. This is important when choosing providers for ABA therapy.
Reviewing the geographic restrictions in your policy can save you time and money. If you need an out-of-network provider, we can guide you through the steps to request exceptions or reimbursements.
Coverage for Complementary Therapies
Many plans in Florida also cover complementary therapies such as occupational or speech therapy alongside ABA. This can greatly benefit your child’s overall development.
Checking if your plan includes these additional therapies can maximize the benefits you receive. Our team is available to help you review your policy.
Reimbursements for Out-of-Network Services
In Florida, some insurance plans offer reimbursements for ABA services provided out of network, depending on the coverage percentages.
These reimbursements typically require specific documentation, such as invoices and progress reports. We can assist you in preparing this information to streamline the process.
Annual Policy Updates
Insurance policies in Florida are often updated annually. It is crucial to review changes in coverage, deductibles, and benefits to ensure they continue to meet your needs.
Evaluating your policy each year can help you avoid surprises and better plan your finances for ABA services. We are available to assist you with this review.

For families in Florida, navigating the world of healthcare and insurance can be overwhelming, especially when seeking the best treatments for developmental conditions. Thankfully, Florida Medicaid and Florida KidCare provide coverage for ABA therapy, which is recognized as the most effective treatment for Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Global Developmental Delay (GDD). While private insurance companies typically cover ABA therapy only for Autism treatment, they may also approve coverage for other behavioral conditions like ADHD, ODD, and GDD on a case-by-case basis. We work with most healthcare providers, including Medicaid and private insurance plans such as Ambetter Health, Aetna, United Healthcare, Tricare, Humana, BlueCross BlueShield, Molina, Oscar, Cigna Healthcare, and more. Need help understanding your health insurance? Call us today at 954-800-7007, and we’ll help you understand the benefits your insurance offers for ABA therapy. We are committed to guiding you through your insurance policy and ensuring you get the support you need.