Does Anthem Cover ABA Therapy?
Yes! Anthem, a major health insurance provider, offers coverage for Applied Behavior Analysis (ABA) therapy for children diagnosed with Autism Spectrum Disorder (ASD). This coverage helps ensure that families can access essential autism services with minimal out-of-pocket costs. However, there are certain eligibility requirements and conditions that must be met for coverage under Anthem’s plans.
Requirements for ABA Therapy Coverage Under Anthem
To qualify for ABA therapy coverage through Anthem, your child must meet the following criteria:
- Autism Diagnosis: A formal diagnosis of Autism Spectrum Disorder (ASD) from a licensed healthcare provider.
- Anthem Enrollment: Your child must be enrolled in an Anthem health insurance plan, including Medicaid or commercial insurance.
- Referral for ABA Therapy: A recommendation for ABA therapy as part of your child’s treatment plan from an approved healthcare professional.
- Initial and Ongoing Assessments: Your child must undergo an initial assessment and periodic re-evaluations to confirm the continued need for therapy services.
Limitations and Conditions for ABA Coverage
While Anthem covers ABA therapy, there are some important limitations and conditions to consider:
Pre-authorization Required
Anthem requires that ABA therapy services are pre-approved before treatment can begin.
Age Restrictions
Anthem may prioritize coverage for children within a specific age range, generally focusing on younger children in the early stages of autism treatment.
In-Network Provider Requirements
Therapy must be provided by an Anthem-approved in-network provider. Precious Care ABA is an in-network provider for Anthem plans.
Session Limits
Anthem may set limits on the number of therapy hours covered per week, unless additional medical justification is provided to extend the hours.
Understanding these conditions ensures that your child’s ABA therapy can proceed smoothly without unexpected interruptions.
How to Verify and Navigate Anthem Coverage for ABA Therapy
Navigating Anthem coverage for ABA therapy may feel overwhelming, but following these steps can make the process more manageable:
Review Your Plan Details
Review your Anthem policy documents or contact Anthem customer service to confirm the specific ABA therapy benefits included in your plan.
Obtain an Autism Diagnosis
Your child must have a formal autism diagnosis from an accredited healthcare provider.
Get a Referral
Obtain a referral for ABA therapy from your child’s pediatrician or another healthcare professional.
Submit Pre-Authorization
Submit the required documentation to Anthem to secure pre-authorization for ABA therapy.
Choose an In-Network Provider
Make sure to choose an ABA provider like Precious Care ABA that is in-network with Anthem.
Schedule an Assessment
A Board Certified Behavior Analyst (BCBA) will evaluate your child and develop a customized treatment plan based on their specific needs.
How Precious Care ABA Helps with Anthem Coverage
At Precious Care ABA, we strive to make accessing ABA therapy through Anthem as seamless as possible. Our services include:
Insurance Verification
Insurance Verification
We verify your Anthem coverage and explain your benefits in detail.
Pre-Authorization Assistance
Pre-Authorization Assistance
We assist with gathering the necessary documentation and submitting pre-authorization requests to Anthem.
Coordination with Healthcare Providers
Coordination with Healthcare Providers
We work closely with your child’s healthcare providers to ensure that all necessary referrals and medical records are in order.
Comprehensive ABA Services
Comprehensive ABA Services
Once pre-authorization is granted, we provide high-quality, individualized ABA therapy that meets your child’s unique needs.
Ongoing Support
Ongoing Support
We help manage Medicaid renewals, re-evaluations, and any required adjustments to your child’s therapy plan to keep services consistent.
Let’s Get Started!
If you’re seeking ABA therapy covered by Anthem, Precious Care ABA is here to support you every step of the way. Reach out today to learn more about how we can help your child achieve success with personalized ABA therapy.
Frequently Asked Questions
Anthem covers ABA therapy for children diagnosed with Autism Spectrum Disorder (ASD), provided they meet eligibility requirements, including a formal diagnosis, a treatment plan recommendation, and pre-authorization. Age restrictions and session limits may apply depending on the specifics of your plan.
To verify coverage, review your Anthem policy documents, contact Anthem customer service, or consult with an in-network ABA provider like Precious Care ABA, who can assist in confirming your benefits and coverage.
If your ABA therapy coverage is denied by Anthem, you have the right to appeal the decision. Precious Care ABA can help you gather the necessary documentation, submit an appeal, and work with Anthem to secure approval for therapy services.
Anthem typically requires periodic re-evaluations to assess the ongoing medical necessity of ABA therapy. These re-evaluations typically occur every 6 to 12 months, depending on your plan and your child’s progress. Our team helps manage re-assessments to prevent therapy interruptions.
Pre-authorization requests usually take a few weeks to process. Precious Care ABA ensures all necessary documents are submitted promptly to minimize delays in approval.
If you have any additional questions about ABA therapy coverage under Anthem, feel free to reach out to Precious Care ABA today!