Does Anthem Cover ABA Therapy?

Applied Behavior Analysis (ABA) therapy is a form of treatment that has been found to be effective for individuals with autism spectrum disorders (ASD).

ABA therapy involves the use of behavioral techniques to help individuals learn new skills, such as communication and social interaction.

However, this type of therapy can be costly, and not all insurance providers cover it. In this article, we will take a closer look at Anthem coverage for ABA therapy, including its benefits and limitations.

How Much Anthem Covers ABA Therapy

When it comes to Anthem coverage for ABA therapy, the amount of coverage can vary depending on a number of factors. These factors may include the type of plan you have, your state of residence, and the severity of your child's condition.

ABA therapy is often covered under mental health benefits rather than medical benefits. This means that there may be different deductibles, copays, and out-of-pocket maximums for ABA therapy compared to other medical services.

Additionally, some Anthem plans may limit the number of ABA therapy sessions that are covered per year or per lifetime.

It is important to carefully review your specific plan details to fully understand what is covered and what costs you may be responsible for.

Anthem offers several coverage plans for autism therapy, including ABA therapy. These plans vary depending on the state you live in and the type of plan you have. For example, Anthem's HMO plans may have different coverage options than their PPO plans.

It is important to note that not all Anthem plans cover autism therapy, so it is important to check with your specific plan to see what is covered. Additionally, some plans may require pre-authorization or a referral from a primary care physician before beginning any autism therapy.

When reviewing your Anthem coverage plan for autism therapy, it is also important to consider the network of providers available to you.

Some plans may only cover services provided by in-network providers, while others may allow out-of-network providers with higher cost-sharing.

Overall, understanding your specific Anthem coverage plan for autism therapy can help you make informed decisions about your healthcare needs and ensure that you are able to access the services your child needs.

Limitations of ABA Therapy Coverage Under Anthem

While ABA therapy has many benefits, it can also be expensive. Many insurance providers do not cover this type of therapy, or they only cover a limited number of sessions. Anthem is one insurance provider that does offer coverage for ABA therapy, but there are limitations to this coverage.

Under Anthem, ABA therapy is covered for individuals with ASD up to the age of 21. The coverage includes up to 30 hours of therapy per week, with a maximum benefit of $36,000 per year. However, this coverage is subject to certain conditions.

One of the conditions is that the therapy must be deemed medically necessary by a licensed physician or psychologist.

This means that the individual must have a diagnosis of ASD and a treatment plan that includes ABA therapy. Additionally, the therapy must be provided by a licensed provider who is trained in ABA therapy.

Another limitation of Anthem coverage for ABA therapy is that it may not cover all aspects of the therapy. For example, some therapies may be excluded from coverage, such as parent training or group therapy sessions.

It is important for individuals and families to carefully review their insurance policy to understand what is covered and what is not.

Conclusion

ABA therapy can be an effective form of treatment for individuals with ASD, but it can also be expensive.

Anthem coverage for ABA therapy offers some benefits, such as coverage for up to 30 hours of therapy per week, but it also has limitations, such as the need for medical necessity and exclusion of certain therapies.

If you or a loved one is considering ABA therapy, it is important to speak with your insurance provider to understand what is covered under your policy.