ABA Coding Coalition (July 2019)
Applied Behavior Analysis (ABA) and Health Insurance
From Autism Speaks | Your type of plan determines which health benefits must be covered. Some plan types (e.g., “fully insured plans”) must provide benefits directed by state law while other plan types do not. Forty-eight states have taken government action to require coverage for ABA. Fully insured plans must comply with these laws, but self-funded plans do not. Self-funded plans are regulated by federal law – not state law. Your type of plan impacts how you advocate for a change in benefits. Subject to state and/or federal law, benefits are determined by the employer in self-funded plans but by the insurance company in fully insured plans. If you are covered by a self-funded plan, you would advocate at the level of your employer. If you have a fully insured plan, your employer has no control over plan design. It is usually necessary to advocate for a change in state law. Your type of plan may affect how to appeal denials of coverage and to whom you file complaints if you are not satisfied with implementation of benefits.