Does Anthem Cover ABA Therapy?

Does Anthem Insurance Cover ABA Therapy?

The good news is that Anthem insurance does cover ABA therapy for children with ASD. However, the specifics of the coverage may vary depending on your specific insurance plan.

It is important to review your plan documents or contact Anthem customer service to determine what your plan covers.

In general, Anthem insurance plans cover ABA therapy as a medically necessary treatment for children with ASD.

This means that if your child has been diagnosed with ASD and ABA therapy is recommended by a healthcare professional, your Anthem insurance plan should cover the cost of the therapy.

It is important to note that there may be some limitations on the coverage.

For example, your plan may have a limit on the number of therapy sessions that are covered each year.

Additionally, your plan may require that the therapy be provided by a licensed therapist who is in-network with Anthem.

How to Access ABA Therapy with Anthem Insurance

If you have Anthem insurance and your child has been diagnosed with ASD, accessing ABA therapy is relatively straightforward. Here are the steps you should take:

1. Get a diagnosis: Your child will need to be diagnosed with ASD by a healthcare professional in order for ABA therapy to be covered by your Anthem insurance plan.
2. Get a referral: Your child's healthcare provider will need to refer your child to a licensed ABA therapist who is in-network with Anthem.
3. Get pre-authorization: Before your child can begin ABA therapy, your Anthem insurance plan may require pre-authorization. This means that you will need to submit a request to Anthem to approve the therapy.
4. Begin therapy: Once your child has been approved for ABA therapy, they can begin working with a licensed therapist to develop new skills and behaviors.

How to Find an In-Network Licensed ABA Therapist with Anthem Insurance

Finding an in-network licensed ABA therapist with Anthem insurance is a crucial step in accessing ABA therapy for your child. Here are some steps to help you find the right therapist:

1. Check your plan documents: The first step is to check your Anthem insurance plan documents to see which therapists are considered in-network. You can typically find this information on the Anthem website or by contacting customer service.
2. Ask for referrals: Your child's healthcare provider may be able to provide you with a list of licensed ABA therapists who are in-network with Anthem. You can also ask other parents of children with ASD for recommendations.
3. Use the provider search tool: Anthem has a provider search tool that allows you to search for licensed therapists who are in-network with your insurance plan. You can use this tool to find therapists based on location, specialty, and other criteria.
4. Verify credentials: Once you have identified potential therapists, it is important to verify their credentials before making a decision. You can check their license status on the state licensing board website and review their experience and qualifications.
5. Consider other factors: In addition to being in-network and licensed, there may be other factors that are important to consider when choosing an ABA therapist for your child, such as their experience working with children with ASD, their approach to therapy, and their availability.

By following these steps, you can find an in-network licensed ABA therapist with Anthem insurance who can provide high-quality care for your child and help them develop new skills and behaviors.

Other Types of Therapy Covered by Anthem Insurance

In addition to ABA therapy, there are other types of therapy and treatments that may be covered by Anthem insurance for children with ASD. Here are some examples:

1. Speech Therapy: Speech therapy is a type of treatment that focuses on improving communication skills, such as language comprehension, speech production, and social communication. Anthem insurance plans may cover speech therapy as a medically necessary treatment for children with ASD.
2. Occupational Therapy: Occupational therapy is a type of treatment that helps children develop the skills they need to perform everyday activities, such as dressing, eating, and playing. This type of therapy may be recommended for children with ASD who have difficulty with fine motor skills or sensory processing. Anthem insurance plans may cover occupational therapy as a medically necessary treatment.
3. Physical Therapy: Physical therapy is a type of treatment that focuses on improving gross motor skills and overall physical function. Children with ASD may benefit from physical therapy if they have difficulty with coordination or balance. Anthem insurance plans may cover physical therapy as a medically necessary treatment.

It is important to note that the specifics of coverage for these types of therapies may vary depending on your specific insurance plan.

It is recommended that you review your plan documents or contact Anthem customer service to determine what types of therapies and treatments are covered under your plan.

If you believe your child would benefit from any of these therapies or treatments, talk to their healthcare provider about getting a referral and pre-authorization from Anthem before beginning any services.

By working with their healthcare team and utilizing their insurance benefits, you can help your child get the care they need to reach their full potential.