Does Horizon Commercial Cover ABA Therapy?
Yes! Horizon Commercial, a leading health insurance provider, covers Applied Behavior Analysis (ABA) therapy for children diagnosed with Autism Spectrum Disorder (ASD). This coverage ensures that families have access to essential autism services, minimizing out-of-pocket costs for the therapy that is critical for your child’s development. However, there are specific eligibility requirements and conditions that must be met under Horizon’s commercial insurance plans.
Requirements for ABA Therapy Coverage Under Horizon Commercial
To qualify for ABA therapy under Horizon Commercial, your child must meet the following criteria:
- Autism Diagnosis: Your child must have a formal diagnosis of Autism Spectrum Disorder (ASD) from a licensed healthcare provider.
- Horizon Commercial Enrollment: Your child must be enrolled in a Horizon Commercial health insurance plan.
- Referral for ABA Therapy: A recommendation for ABA therapy must be part of your child’s treatment plan, provided by an approved healthcare professional.
- Initial and Periodic Assessments: Your child will need an initial assessment, followed by periodic evaluations to determine continued medical necessity and progress.
Limitations and Conditions for ABA Coverage
While Horizon Commercial covers ABA therapy, there are some important limitations and conditions to keep in mind:
Pre-authorization Required
ABA therapy services must be pre-approved by Horizon Commercial before therapy sessions can begin.
Age Restrictions
Coverage for ABA therapy may be prioritized for children within a certain age range, generally focusing on younger children in the early stages of autism treatment.
In-Network Provider Requirements
ABA therapy services must be provided by an in-network provider, like Precious Care ABA. Our team is in-network with Horizon Commercial.
Session Limits
Horizon Commercial may set limits on the number of therapy hours per week. However, additional justification from your healthcare provider may allow for additional therapy hours if needed.
Being aware of these conditions is important to ensure that your child can receive uninterrupted ABA therapy services.
How to Verify and Navigate Horizon Commercial Coverage for ABA Therapy
Navigating Horizon Commercial’s ABA therapy coverage can seem complex, but following these simple steps will help guide you through the process:
Review Your Plan Details
Start by reviewing your Horizon Commercial policy documents or contacting Horizon customer service to confirm the specific ABA therapy benefits in your plan.
Obtain an Autism Diagnosis
Your child must have a formal diagnosis of Autism Spectrum Disorder (ASD) from a licensed healthcare provider.
Get a Referral
Obtain a referral from your child’s pediatrician or specialist recommending ABA therapy as part of the treatment plan.
Submit Pre-Authorization
Submit the required documentation to Horizon Commercial to obtain pre-authorization for ABA therapy.
Choose an In-Network Provider
Ensure that you select an in-network ABA provider, such as Precious Care ABA, to avoid out-of-network costs.
Schedule an Assessment
A Board Certified Behavior Analyst (BCBA) will assess your child’s needs and create a customized treatment plan.
How Precious Care ABA Helps with Horizon Commercial Coverage
At Precious Care ABA, we aim to simplify the process of accessing ABA therapy through Horizon Commercial insurance. Here’s how we assist you:
Insurance Verification
Insurance Verification
We’ll verify your Horizon Commercial coverage and provide a clear explanation of your benefits.
Pre-Authorization Assistance
Pre-Authorization Assistance
We help you gather the necessary documentation and submit pre-authorization requests to Horizon Commercial.
Coordination with Healthcare Providers
Coordination with Healthcare Providers
We work directly with your child’s doctors and specialists to ensure that all referrals and medical records are in order.
Comprehensive ABA Services
Comprehensive ABA Services
Once pre-authorization is approved, we offer high-quality ABA therapy tailored to your child’s specific needs and goals.
Ongoing Support
Ongoing Support
Our team helps manage the process of Medicaid renewals, re-evaluations, and necessary adjustments to the therapy plan to ensure continuity of care.
Let’s Get Started!
If you’re seeking ABA therapy covered by Horizon Commercial, Precious Care ABA is here to guide you through every step of the process. Our goal is to help your child succeed through personalized, evidence-based ABA therapy.
Take the first step toward quality ABA therapy for your child!
Frequently Asked Questions
Horizon Commercial provides coverage for ABA therapy for children diagnosed with Autism Spectrum Disorder (ASD). However, your child must meet certain eligibility requirements, including a formal diagnosis, treatment plan referral, and pre-authorization. Some age restrictions and session limits may apply depending on your specific plan.
To verify your coverage, review your Horizon Commercial policy documents, contact Horizon customer service, or speak with an in-network ABA provider like Precious Care ABA, who can assist in confirming your coverage and benefits.
If Horizon Commercial denies your child’s ABA therapy coverage, you have the right to appeal. Precious Care ABA can help gather the necessary documentation, assist with the appeal process, and work with Horizon to secure approval for therapy services.
Horizon Commercial typically requires periodic re-evaluations to confirm that ABA therapy remains medically necessary. These re-evaluations generally take place every 6 to 12 months, depending on the specifics of your plan and your child’s progress. We’ll help manage this process to avoid disruptions in therapy.
The pre-authorization process usually takes a few weeks. Precious Care ABA works quickly to submit all the necessary documents, minimizing delays and ensuring your child’s therapy starts as soon as possible.
If you have additional questions about ABA therapy coverage under Horizon Commercial, don’t hesitate to reach out to Precious Care ABA today!