Understanding Insurance Coverage for Autism Therapy
At Sunshine Spectrum, we specialize in helping you navigate your insurance options and understand the financial aspects before beginning treatment. If you have any questions about insurance coverage for ABA therapy, don’t hesitate to contact us. We're committed to supporting you every step of the way.
Insurance Questions?
Insurance Authorization Usually Takes One to Two Weeks
The cost of ABA therapy varies based on your insurance coverage and the number of treatment hours your child requires.
We can estimate the coverage amounts after determining how many hours of ABA therapy your child needs.
Deductibles, Copays, Coinsurance, and Out-of-Pocket Maximums
You may need to meet a deductible, which is the amount you must pay for covered healthcare services before your insurance starts contributing.
Some insurance plans include coinsurance, requiring you to pay a set percentage of the bill until you reach an out-of-pocket maximum, after which insurance covers 100% of the costs.
Other plans feature copays, which are fixed payments per service day. Families will continue making these copayments until reaching the out-of-pocket maximum, after which insurance covers all expenses.
Exclusions and Limitations of Benefits
If you see the term “exclusion of benefits,” it means the insurance plan does not cover a particular service and will not authorize or reimburse for it. If your plan excludes ABA services, you might be able to work with your employer or insurance provider to add these services.
Some plans have limitations on age ranges, yearly hours, or total monetary caps (e.g., $30,000 annually). We can help you identify any limitations in your insurance plan so you can plan accordingly.
