Does Anthem Cover ABA Therapy?

What is Anthem Insurance?

Anthem is one of the largest health insurance companies in the United States. It offers a wide range of health insurance plans, including individual, family, and group plans. Anthem provides coverage for medical and behavioral health services, including mental health and substance abuse treatment.

Does Anthem Cover ABA Therapy?

Yes, Anthem covers ABA therapy. However, the coverage may vary depending on the plan and the state you live in. Some Anthem plans may cover ABA therapy as a medical benefit, while others may cover it as a behavioral health benefit.

In some states, ABA therapy may be covered under the mental health parity law, which requires insurance companies to provide the same level of coverage for mental health and substance abuse treatment as they do for medical treatment.

It is important to note that Anthem may have specific requirements for ABA therapy coverage.

For example, the therapy may need to be provided by a licensed or certified provider, and the treatment plan may need to be approved by Anthem. Additionally, there may be limits on the number of therapy sessions or the duration of the treatment.

How to Check Your Anthem Plan for ABA Therapy Coverage

If you are an Anthem member and you want to know if your plan covers ABA therapy, you can check your plan documents or contact Anthem customer service. You can also ask your ABA therapy provider to check your coverage and help you navigate the insurance process.

How to Find an ABA Therapy Provider That Accepts Anthem Insurance

Finding an ABA therapy provider that accepts Anthem insurance can be a daunting task, but there are resources available to help you. One option is to use Anthem's online provider directory, which allows you to search for providers by location, specialty, and insurance plan.

You can also ask your primary care physician or pediatrician for a referral to an ABA therapy provider who accepts Anthem insurance.

Another resource is the Autism Speaks Provider Directory, which provides a list of ABA therapy providers in your area.

The directory includes information on each provider's qualifications, services offered, and insurance accepted. Additionally, local autism advocacy groups may have information on ABA therapy providers in your area who accept Anthem insurance.

Once you have identified potential ABA therapy providers who accept Anthem insurance, it is important to do your research and ask questions. Some questions you may want to ask include:

• What specific services does the provider offer?
• What experience does the provider have working with children with ASD?
• Is the provider licensed or certified?
• Does the provider have experience working with Anthem insurance?

By doing your research and asking questions, you can find an ABA therapy provider who meets your child's needs and accepts your Anthem insurance plan.

What to Do if Your Anthem Plan Does Not Cover ABA Therapy

If your Anthem plan does not cover ABA therapy or has limited coverage, there are still options available to you. One option is to appeal the denial of coverage with Anthem. You can start by contacting Anthem customer service and asking for a review of your claim.

When appealing a denial of coverage, it is important to provide as much information as possible about your child's diagnosis and the need for ABA therapy.

You may also want to enlist the help of an attorney or advocacy group that specializes in autism-related legal issues.

Another option is to seek out alternative funding sources for ABA therapy. Some states offer Medicaid waivers that cover ABA therapy for children with ASD. There are also nonprofit organizations that provide financial assistance for ABA therapy, such as the Autism Treatment Assistance Program (ATAP) and the National Autism Association's Helping Hand Program.

Finally, you may want to consider changing insurance plans during open enrollment if your current plan does not provide adequate coverage for ABA therapy. It is important to research different plans and compare their benefits before making a decision.

Remember, there are resources available to help you navigate the insurance process and find the best treatment options for your child with ASD. Don't hesitate to reach out for help if you need it.

Conclusion

In summary, Anthem does cover ABA therapy, but the coverage may vary depending on the plan and the state you live in. If you are an Anthem member and you want to know if your plan covers ABA therapy, you can check your plan documents or contact Anthem customer service.

ABA therapy can be a life-changing treatment for children with ASD, and knowing that it is covered by insurance can provide peace of mind for parents.