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Everything You Need to Know About Navigating Insurance and ABA Services

On January 1, 2010, Connecticut passed the autism insurance bill entitled Substitute Senate Bill 301/Public Act 09-115, requiring meaningful coverage for autism under state-regulated plans. These services include diagnosis, behavioral therapy, prescription drugs, psychiatric or psychological care, and speech, occupational, or physical therapy. In 2014, the dollar and age caps were removed for Applied Behavior Analysis (ABA) coverage. The SEED Center is an in-network provider for ABA services with United Healthcare, Aetna, ConnectiCare, Oxford Health Plans, UMR, First Health, and Coventry, with more insurance companies to be added in the near future! As an in-network provider, The SEED Center bills your insurance company directly and the client is only responsible for a co-pay or a payment towards the deductible, depending on the insurance company. Finding an in-network provider for your child’s ABA services makes the process of receiving coverage easier overall.

Below are the 4 distinct, but overlapping services required for ABA therapy, which insurance companies typically cover:

  • Direct (to client) by Behavior Technician: Behavior Technicians provide ABA therapy directly to the client
  • Supervision by BCBA or LMHP: The Board Certified Behavior Analyst (BCBA) or Licensed Mental Health Professional (LMHP) will supervise the Behavior Technician during services to ensure the behavior interventions are being implemented, and that data is being collected consistently and in line with the behavior program.
  • Direct (to parent/caregiver) by BCBA or LMHP: The BCBA or LMHP provides services directly to the parent or caregiver. Training is provided on the ABA strategies and interventions that have been successful in the client’s sessions and can be carried out when the Behavior Technician is not present.
  • Assessment and Treatment Planning by a BCBA or LMHP: These services include reviewing treatment notes, creating materials, inputting and graphing data, updating data sheets, and modifying treatment plans. (Please note: these additional, non face-to-face services with the client are required for an ABA program and are subject to deductibles, co-pays, and/or co-insurance.)

Insurance Authorization

All insurance companies require a formal autism diagnosis for coverage of ABA services to be considered. A copy of your insurance card must be submitted for verification of benefits.

Once an insurance authorization is received, the appropriate ABA assessment is selected based on the individual client’s needs. An assessment is an essential step of developing an ABA program and is used to guide the clinical rationale for services, as well as determine the number of ABA service hours requested from the insurance company.

ABA assessments typically include:

  • Intake Meeting: 1-hour appointment with the parent/guardian or client to obtain background information
  • Client Assessment: 2-4 hours of assessment with the client, often spread over 2 days
  • Evaluation Processing: 2-4 hours without the client present for scoring, report writing, and developing the treatment plan and ABA programs
  • Feedback Meeting: A 1-hour feedback meeting with the parent/guardian or client to go over assessment results, service recommendations, an on-going service schedule, and start date

Approval of Requested Service Hours

The number of hours an insurance company approves for ABA services varies from individual to individual. Some factors that impact the amount of authorized hours are clinical rationale for services, age, severity of skill deficits, previous ABA progress, and other ABA services being received in school. The hours requested by the BCBA or LMHP in the insurance authorization for ABA services, are based on the level of need reflected in the ABA assessment.

Client Financial Responsibility

Clients are responsible for co-pays, co-insurance, and/or deductibles, which is determined by your insurance company and are due at the time of services. The SEED Center submits invoices to insurance for in-network services. If you have out-of-network coverage with your insurance, you may be able to submit your paid invoices directly to your insurance company for reimbursement. Private pay options are also available at The SEED Center. 


How to Approach the Holidays With Your Child

The holidays can be a stressful time and an overwhelming time for everyone. For adults, it can be planning parties, going to events, and keeping children entertained. For children, the holidays can be challenging from an overwhelming amount of stimuli. Instead of being stressed and anxious during the holidays, we want to help you provide a fun and relaxed atmosphere for your child.

1) Planning and explaining.

A great way to help a child feel a better sense of control over their situation during the holidays is to explain to your child in advance. This could be explaining or planning out how their days might go or letting them know what kind of events they will be attending. Be sure to give thorough explanations of what the event is, who is going, what it will be like, and so on. This will help your child understand what to expect so they can feel prepared when the time comes.

2) Communicate with your family and friends.

For those who don’t know your child as well as you do, it is important to let them know about your situation ahead of time. This way they can do everything they can to be as supportive as possible.

3) Create a space for your child to have some extra downtime.

If possible, arrange for a place that your child can go when things start to get overwhelming. When your child has a place they can go to that promotes a calm environment, it can help them thrive and relax.

4) Support your child’s nutrition as much as possible.

The holidays are a tough time for everyone’s diet, but it is usually a time where people make exceptions. In this case, however, we need to be more strict. It can be very tempting to let your child eat these sugary foods, but it will be worth it to keep your child’s autism diet in check.

5) Celebrate with positive reinforcement.

It can be easy to focus on the bad and reprimand your child when they are misbehaving, but it is very important to focus on their good behaviors and celebrate those with them. Cheer for them when they flexible, gentle, and well behaved. This way they can feel a sense of success and have a boost in confidence that they are doing the right things.

Again, the holidays are a very hectic time despite them being a time where friends and family gather. In your child’s best interest, plan ahead, reinforce positive behavior, create space for them, and bring others up to speed on the situation. We hope you have a wonderful holiday season and that your child can have a great experience that they remember for years and years.