Insurance Coverage FAQ
Have questions about Insurance?
Check out the most commonly asked questions below and let us know how we can help get the rest of your questions answered.
How long will the authorization from the insurance take?
How much does ABA therapy cost if I have insurance?
It depends on how many hours of ABA your child will be receiving and also how much your insurance covers. Some insurances have co-pays and some have co-insurance. An estimated amount can be calculated once we know how many hours of ABA your child will receive. We will know how many hours of ABA therapy your child will need once the diagnostic assessment has been completed.
What is the difference between co-insurance vs. co-pays?
Co-Insurance- The family is typically responsible for the full deductible before insurance will kick in and cover a set percentage of the bill. The insurance and family will continue to pay their percentages until the family meets the max out of pocket limit (MOP), at which time, insurance will cover services at 100%. Example: 70/30= 70% insurance, 30% family.
- Co-pay- The family will pay a set payment per day for services. This works two ways with different insurance plans; 1. No deductible applies, meaning that the family is only responsible for the copays until MOP is met. 2. Deductible needs to be met before the copay only becomes effective. The family will continue to make co-payments until they reach their max out of pocket limit, at that which time, insurance will cover services at 100%.
What is a deductible?
The deductible is the amount you pay for covered health care services before your insurance plan starts to pay. Different health care plans have different deductibles.
What does "out of pocket max" mean?
The “out of pocket max” is the maximum you’ll have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.
What does it mean if you see "exclusion of benefits?"
This is when an insurance plan does not cover a particular service and will not authorize or reimburse any services rendered.
Often, self funded Plans (when the parent’s company has the ability to work with their insurance broker to add a service to the benefits. Families can talk with their HR dept to petition the serves to be added.) may not be required to cover ABA Services.