Is ABA Therapy Covered by Insurance?

Hopebridge Care and Benefits Coordinators Navigate the Financial ‘Maze’

Spoiler alert: yes, autism therapy services at Hopebridge are covered by many insurance plans!

When you have a child with autism spectrum disorder (ASD) or developmental delays, you have enough on your mind – from how to get a good night’s sleep to how to get a diagnosis. Cost should not be a concern, let alone one that holds children back from the life-changing care they need.

Hopebridge has fought to give parents peace of mind in this area since its early beginnings, and health insurance has come a long way since 2005. We remember a time when Hopebridge Founder Kim Strunk had to work diligently to make sure families touched by autism not only had access to early intensive behavioral interventions like applied behavior analysis (ABA therapy), but also the coverage that made it possible (versus cost-prohibitive) to receive it.

A Team Dedicated to Insurance Support

Thankfully, families now have options, but depending on where you receive treatment, the process is still not always easy. We know how hard it is for families to manage everything, as well as the impact it can have on a child. Our work is centered around simplifying life for families, so it is important to us that all of Hopebridge’s services align with this mission – from the get-go.

That is why all of our programs include insurance verification support from a dedicated team of Care and Benefits Coordinators … even before your child is a patient! This team connects with parents within days of receiving a referral, acting as a liaison between the primary physician and insurance company. Their extensive experience navigating insurance for thousands of other families enables them to get the job done while personalizing the process. They aim to handle everything from authorizations to plan changes, all in an effort to save parents added time and stress.

“Our advocates happily take this onto our shoulders so parents do not have the hassle. We act as the middleman to research plans and go back and forth with insurance companies and pediatricians to make sure we can get their children in for diagnostic testing and therapy,” said Jennifer Morgan, client advocate team lead for Hopebridge’s Care and Benefits team. “Our jobs exist to make life easier for these families.”

What will caregivers pay out of pocket for an evaluation or therapy? It varies from state to state and plan to plan, but the families we work with learn the cost up front.

“There should be no surprises on cost,” said Jennifer. “Once we have a referral that includes plan information, we will be in touch to walk you through which portion your insurance covers, which could be anywhere from the entire cost to a small percentage.”

Then, once the child has the ABA evaluation, a board certified behavior analyst (BCBA) will share the recommended number of hours for therapy. At that time, we can tell caregivers if there is a cap to services so they understand how much will be covered.

Our Care and Benefits Coordinators act as liaisons, collecting all the necessary information from insurance providers – so you don’t have to!

What are Your Coverage Options at Hopebridge?

Hopebridge’s Care and Benefits team specializes in getting children the care they need, but there is not just one way to get there. Providing your child with the tools for a more independent life is our main goal, so we work to ensure families understand the available coverage options, which include:

• Health insurance
  Hopebridge works with a range of commercial insurance companies and our Care and Benefits Coordinators can help you navigate your coverage and out-of-pocket costs. We also know plans change, so our specialists are flexible and prepared to shift gears alongside you should yours incur any updates.
• Medicaid
  For those with Medicaid coverage through one of our preferred payers and have a physician referral, Hopebridge will bill for services on your behalf whether as a Primary or Secondary payer.* From the beginning, it was important to Hopebridge’s founder to discover options and opportunities so those using Medicaid would have access to these crucial services. The autism community has made great strides over the years to receive its funding and our advocates continue to work with the system for Hopebridge families.

For a full list of preferred payers by state, click here.

Since Hopebridge has autism therapy centers in Ohio, some families have asked if we are an Ohio Autism Scholarship provider. As a medical model, Hopebridge’s diagnostic and therapy services are strictly insurance-based. Ohio’s parents still do not need to worry; even without the scholarship – many are still covered! Through insurance and Medicaid, we have been able to get hundreds of Ohio’s children into to one-on-one ABA therapy at Hopebridge, starting at 15 months of age.

Simply put, every child deserves a chance at therapy, and our goal is to get them the chance through affordable access.

If you are interested in exploring the therapy opportunities for your child or speaking to a Care and Benefits Coordinator about the cost of services, please reach out to us on the Hopebridge website.

State-Level Insurance Limitations:

• *At this time, Hopebridge services are not supported by Medicaid within the state of Minnesota. We do plan to add Medicaid in the near future.