Insurance for ABA Therapy in Florida
BCBS • Aetna • Cigna • UMR • Personify Health • TRICARE • Self-pay
Insurance rules for ABA therapy can feel confusing. The good news is that many Florida families have some coverage for it. Hope Center for Behavior Change accepts Blue Cross Blue Shield, Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East (Humana Military), with Optum coming soon. Self-pay is available for every service, with a sliding scale. Before therapy starts, we check your benefits for free and explain what your plan covers, what it needs from you and what your costs may be. Here is a plain overview of how coverage usually works.
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- BCBA-led programs
- BCBS, Aetna, Cigna, UMR, TRICARE
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The short answer
Hope Center for Behavior Change accepts Blue Cross Blue Shield, Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East, and offers self-pay with a sliding scale for deductibles and copays. Insurance-funded ABA usually needs an autism or Down syndrome diagnosis and prior authorization. We check your benefits for free first.
Does insurance cover ABA therapy in Florida?
Often, yes. Whether your child’s plan covers ABA, and how much you pay, depends on what kind of plan you have. The main types are state-regulated group plans, self-funded employer plans, Florida Medicaid and TRICARE.
Hope Center for Behavior Change accepts Blue Cross Blue Shield, Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East (Humana Military). Optum is coming soon. We check your benefits before therapy starts and go over them with you.
Worried about deductibles or copays? We offer a sliding scale to help, so many families pay little or nothing out of pocket. Self-pay is available for every service, with or without a diagnosis.
We'll check your benefitsWhat does Florida’s autism insurance law require?
Florida law (sections 627.6686 and 641.31098 of the Florida Statutes) requires many group health insurance policies and group HMO plans to cover autism screening and treatment, including applied behavior analysis, speech therapy, occupational therapy and physical therapy.
- It applies to group policies sold by insurers and group HMO contracts issued or renewed on or after April 1, 2009.
- It covers people under 18, or 18 and older and still in high school, who were diagnosed with a developmental disability at age 8 or younger.
- Treatment must follow a treatment plan prescribed by the child’s treating physician.
- It does not apply to individual-market plans, individually underwritten plans or plans sold to small employers.
- Plans can still apply their usual rules, such as network requirements, deductibles and utilization review.
Many larger employers pay claims themselves. These self-funded plans are not policies sold by an insurer, so they generally fall outside this state law and follow federal rules instead. Your plan documents say what they cover, so it is worth asking.
Do you accept Medicaid?
Florida Medicaid covers behavior analysis services for eligible recipients under 21 who need them for medical reasons. The Agency for Health Care Administration (AHCA) sets the rules in its Behavior Analysis Coverage Policy (Rule 59G-4.125).
Every Medicaid behavior analysis service needs prior authorization. AHCA asks families to get a written order from their doctor and a diagnostic evaluation, then to work with their Medicaid health plan to find a provider in its network.
Hope Center does not currently accept Medicaid. Families with Medicaid can still choose self-pay with our sliding scale, or ask their Medicaid health plan for a provider in its network.
Does TRICARE cover ABA therapy?
Yes. TRICARE covers ABA through the Autism Care Demonstration (ACD), run by the Defense Health Agency. Your child needs an autism diagnosis from a TRICARE-approved provider, a referral and pre-authorization before therapy starts.
Hope Center for Behavior Change accepts TRICARE. Read more on our TRICARE for ABA therapy page, or see our page for military families.
What do insurance plans usually need before ABA starts?
- 1A diagnosisA written diagnosis from a qualified provider, such as a developmental pediatrician, child psychologist, psychiatrist or pediatric neurologist. BCBAs do not diagnose.
- 2A prescription or referralMost plans want an order or referral for ABA from your child’s doctor or diagnosing provider.
- 3An assessment and treatment planA BCBA assesses your child and writes an individualized treatment plan, which is sent to your plan. The assessment takes 2–4 hours, at our center or at home, in one or two sessions, and finalizing the plan can take up to two weeks.
- 4Prior authorizationThe plan reviews the request and approves a set number of services for a set period. Authorizations are renewed with updated progress reports. Once the plan is approved, services usually begin within 3–5 business days.
Our team guides you through each of these steps.
Questions to ask your insurance
If you call your plan yourself, these questions help. The number is usually on the back of your insurance card.
- Does my plan cover ABA therapy for my child’s diagnosis?
- Is my plan fully insured or self-funded?
- Do I need a referral, a prescription or prior authorization?
- Is there a deductible, copay or coinsurance for ABA?
- Is there a limit on visits, hours or dollars per year?
- Does my plan cover ABA at home, in the community and at school?
- Is parent training covered?
- What are my costs if a provider is out of network?
Or skip the phone call. Send us your insurance details and we’ll check your benefits for free.
Ask us to check your benefitsQuestions families ask
Do you accept my insurance?+
We accept Blue Cross Blue Shield, Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East (Humana Military), and Optum is coming soon. We do not currently accept Medicaid. Call 561-337-8865 or send the form and we check your benefits for free before therapy starts.
How much will ABA therapy cost?+
It depends on your plan’s deductible, copays and coinsurance. We check your benefits first and explain your share. Our sliding scale can help with deductibles and copays, so many families pay little or nothing out of pocket, and self-pay is available for every service.
Does Florida’s autism mandate cover my child?+
It covers many group insurance and HMO plans, for children under 18, or older and still in high school, who were diagnosed with a developmental disability at age 8 or younger. It does not cover individual-market or small-employer plans, and self-funded employer plans generally follow federal rules. Your plan can confirm.
Do I need an autism diagnosis to use insurance for ABA?+
Most plans need a written diagnosis from a qualified provider, such as a developmental pediatrician, child psychologist, psychiatrist or pediatric neurologist. Many also need a prescription or referral for ABA. If you do not have a diagnosis yet, call us and we can talk through next steps.
What is prior authorization?+
Prior authorization is your plan’s approval before services start. After the BCBA assessment, the treatment plan is sent to your insurance, which reviews it and approves a set amount of therapy for a set time. It is renewed with progress updates. Timing depends on your plan. There is no waitlist: from your first call it can take as little as three weeks to start, and once the plan is approved, services usually begin within 3–5 business days. Slow paperwork or insurance replies can stretch this to a few months.
Related
- New familiesWhat happens first, what to have ready and how ABA starts at Hope Center.Learn more →
- TRICARE for ABA therapyHow TRICARE’s Autism Care Demonstration covers ABA, and how we help you start.Learn more →
- ABA assessmentsABA skills and functional behavior assessments that lead to a clear, individualized treatment plan.Learn more →
- Military familiesABA therapy that keeps up with PCS moves and deployments. TRICARE accepted.Learn more →
Let us check your benefits
Send us your insurance details and we’ll check your benefits for free, then explain your coverage and next steps.
Our ABA programs are developed by Board Certified Behavior Analysts (BCBAs) and carried out by Registered Behavior Technicians.
- No cost to talk to us
- No waitlist: starting can take as little as three weeks from your first call
- Free benefits check, sliding scale and self-pay options
- Our operations team calls you back