Does Fidelis Cover ABA Therapy?
Yes! Fidelis, a health insurance provider, offers coverage for Applied Behavior Analysis (ABA) therapy for children diagnosed with Autism Spectrum Disorder (ASD). This coverage helps families access essential autism services with minimal out-of-pocket expenses. However, certain eligibility requirements and plan conditions must be met for approval.
Requirements for ABA Therapy Coverage Under Fidelis
To qualify for ABA therapy under Fidelis, your child must meet the following criteria:
- Autism Diagnosis: A formal diagnosis of Autism Spectrum Disorder (ASD) from a licensed healthcare provider.
- Fidelis Enrollment: Your child must be enrolled in a Fidelis plan, which may include Medicaid, Managed Care, 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 Periodic Assessments: Your child must undergo an initial assessment and periodic re-evaluations to confirm ongoing medical necessity.
Limitations and Conditions for ABA Coverage
While Fidelis covers ABA therapy, there are specific limitations and conditions:
Pre-authorization Required
ABA therapy services must be pre-approved by Fidelis before treatment begins.
Age Restrictions
Coverage may be prioritized for younger children or those within a specific age range.
Approved Provider Network
ABA therapy must be provided by an in-network provider. Precious Care ABA is an in-network provider for Fidelis.
Session Limits
Fidelis may set limits on the number of therapy hours per week unless additional medical justification is provided.
Understanding these conditions is crucial to ensuring seamless therapy for your child.
How to Verify and Navigate Fidelis Coverage for ABA Therapy
Navigating Fidelis coverage for ABA therapy is easier when you follow these steps:
Review Your Plan Details
Check your Fidelis plan documents or contact customer service to confirm ABA therapy benefits.
Obtain an Autism Diagnosis
Your child must have a formal autism diagnosis from an accredited healthcare provider.
Get a Referral
Obtain a referral from your child’s pediatrician or specialist recommending ABA therapy.
Submit Pre-Authorization
Submit the necessary documentation to Fidelis for approval before starting ABA therapy.
Choose an Approved Provider
Select an ABA provider like Precious Care ABA, which is in-network with Fidelis.
Schedule an Assessment
A Board Certified Behavior Analyst (BCBA) will assess your child’s needs and create a personalized treatment plan.
How Precious Care ABA Helps with Fidelis Coverage
At Precious Care ABA, we help simplify the process of accessing ABA therapy through Fidelis. Our services include:
Insurance Verification
Insurance Verification
We verify your Fidelis coverage and explain your benefits.
Pre-Authorization Assistance
Pre-Authorization Assistance
We guide you through the process of obtaining pre-authorization, including gathering necessary documentation.
Coordination with Healthcare Providers
Coordination with Healthcare Providers
We work with your child’s doctors and specialists to ensure all required referrals and paperwork are in place.
Comprehensive ABA Services
Comprehensive ABA Services
Once approved, we provide individualized ABA therapy to support your child’s development.
Ongoing Support
Ongoing Support
We assist with Medicaid renewals, re-evaluations, and necessary adjustments to the therapy plan.
Let’s Get Started!
If you’re looking for ABA therapy covered by Fidelis, Precious Care ABA is here to guide you through every step of the process. Reach out today to learn how we can help your child succeed with personalized ABA therapy.
Frequently Asked Questions
Fidelis covers ABA therapy for children diagnosed with Autism Spectrum Disorder (ASD), provided they meet the eligibility requirements, including a formal diagnosis, treatment plan referral, and pre-authorization. Age restrictions and session limits may apply based on your plan.
To verify ABA therapy coverage, review your Fidelis plan documents, contact Fidelis customer service, or speak with an in-network ABA provider like Precious Care ABA, who can assist in confirming your benefits.
If Fidelis denies coverage, you have the right to appeal. Precious Care ABA can assist with gathering documentation, submitting an appeal, and working with Fidelis to secure approval for therapy services.
Fidelis typically requires periodic re-evaluations to determine continued medical necessity. These re-evaluations usually occur every 6 to 12 months, depending on the specifics of your plan and your child’s progress. We can help manage this process to avoid therapy interruptions.
Pre-authorization requests generally take a few weeks. Precious Care ABA ensures that all necessary documents are submitted promptly to minimize any delays in approval.
If you have additional questions about ABA therapy coverage under Fidelis, reach out to Precious Care ABA today!