Logo for Level Ahead ABA
Does Amerigroup Cover ABA Therapy?

Does Amerigroup Cover ABA Therapy?

Yes. Amerigroup, a health insurance provider, covers most costs associated with ABA therapy in certain states and under specific conditions. Coverage is typically provided for children with a formal diagnosis of ASD. The diagnosis must meet the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and be made by a qualified healthcare professional such as a licensed psychologist, psychiatrist, or developmental pediatrician​​​​​​.

Applied Behavior Analysis (ABA) therapy is a widely recognized treatment for individuals with autism spectrum disorder (ASD) and other developmental disorders. It focuses on enhancing social, communication, and behavioral skills through evidence-based methods.

Overview of ABA Therapy

Coverage Details and Limits

The specifics of Amerigroup's ABA therapy coverage can vary depending on the plan and the state. Generally, coverage includes:

  • An initial assessment by a Board Certified Behavior Analyst (BCBA) or a licensed psychologist.
  • Ongoing ABA therapy sessions supervised by a BCBA or a licensed psychologist.
  • Parent training sessions.

Coverage limits may include the number of hours per week, the maximum number of sessions per year, and an age limit for coverage. These limits can differ from plan to plan, with some offering up to 40 hours of therapy per week, while others may have a limit of 20 hours​​.


Reimbursement Process

Members seeking reimbursement for ABA therapy must follow these steps:

  • Verify coverage limits in the member's plan.
  • Choose an in-network ABA therapy provider.
  • Obtain preauthorization from Amerigroup, including submitting the child's diagnosis and treatment plan.
  • Begin therapy and submit claims to Amerigroup for reimbursement​​.

Finding an ABA Therapist Accepting Amerigroup Insurance

To find an ABA therapist who accepts Amerigroup insurance:

  • Contact Amerigroup for a list of in-network providers.
  • Use online directories like the BACB directory or the Autism Speaks Provider Directory.
  • Seek recommendations from other parents or healthcare professionals.
  • Ensure the therapist is licensed and certified, and inquire about their experience with Amerigroup insurance​​.

Conclusion

Understanding Amerigroup's coverage for ABA therapy is crucial for families navigating autism care. With its commitment to providing necessary treatments, Amerigroup offers essential support for enhancing the quality of life for individuals with ASD. By familiarizing themselves with coverage details and processes, families can access vital ABA therapy resources efficiently.

FAQ

Q: How do I obtain preauthorization for ABA therapy from Amerigroup?

A: Preauthorization involves submitting the individual's diagnosis and treatment plan to Amerigroup for review. This is usually done by your healthcare provider.

Q: Does Amerigroup cover both speech therapy and ABA therapy?

A:  If an individual requires both speech therapy and ABA therapy, these services may be covered under different parts of the insurance plan. It's important to consult with Amerigroup and your healthcare provider for specific coverage details.

Contact us today to discuss your insurance coverage options together.


Let Level Ahead ABA be your partner on this journey.


Insurances We Accept

At Level Ahead ABA, we simplify the insurance process, ensuring you can access our exceptional ABA therapy with peace of mind.

SET ON INVESTING IN YOUR CHILD’S FUTURE?

Let’s Collaborate Today.

Share by: