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.