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The three numbers
Most of what ABA therapy will cost your family comes down to three numbers in your plan documents.
- Co-pay or coinsurance — what you pay per visit. A co-pay is a fixed amount; coinsurance is a percentage of the session cost.
- Deductible — what you pay out of pocket each year before the plan starts sharing costs.
- Out-of-pocket maximum — the ceiling. Once your spending for the year reaches this number, the plan pays 100% of covered services.
A worked example: suppose a plan has a $2,000 deductible, 20% coinsurance and a $6,000 out-of-pocket maximum. Early in the year, the family pays session costs in full until they have spent $2,000. After that they pay 20% of each session. And once everything they have paid reaches $6,000, they pay nothing more for covered services that year. Therapy that runs year-round often reaches the maximum — which means the real annual cost of ABA is usually closer to the out-of-pocket maximum than to any per-session math.
Questions to ask your insurer
Five questions get you most of the way:
- Does my plan cover ABA therapy? Being with an accepted insurer does not guarantee ABA is covered under your specific policy.
- Does coverage require a diagnosis on file? Most plans require an autism diagnosis before authorizing ABA.
- Is prior authorization required? Most plans approve a set number of hours for a set period, then re-authorize based on progress.
- Are there session or hour limits?
- Is my provider in network? Ask with the provider’s name and location.
You do not have to sort this out alone: we verify benefits for families and tell you what to expect before services begin — see insurance and funding, or just get started and we will check your plan with you.
