Beginning Applied Behavior Analysis (ABA) Therapy

Before a child can begin Applied Behavior Analysis (ABA) therapy, several steps are typically necessary:

Diagnosis

The child must receive an official diagnosis of autism spectrum disorder (ASD)* from a qualified healthcare professional, such as a developmental behavioral pediatrician, neurodevelopmental pediatrician, child neurologist, child psychiatrist, or clinical psychologist.

* Certain medical policies may allow access to ABA therapy without an autism diagnosis. Be sure to review your insurance plan's eligibility and benefits to confirm coverage.

Referral

The diagnosing professional will usually provide a referral for ABA therapy after diagnosing a child with autism spectrum disorder (ASD). Referral for ABA therapy is normally at the end of the diagnostic report.

Medical documentation such as letters of medical necessity, visit or encounter notes, prescriptions, or referral notes differ from a comprehensive diagnosis. A diagnosis involves using a diagnostic instrument, independent medical judgment to determine how diagnostic criteria are met through direct observation of the individual, and a review of collateral documentation. This process is formally documented within a developmental and/or psychometric evaluation conducted by a qualified diagnostic physician or specialist.

The medical necessity for ABA therapy is determined by the severity of the child's signs and symptoms of autism, maladaptive behaviors (such as aggression, self-injury, or tantrums), and their ability to manage self-care and safety skills.

Note: Each insurance company and medical group has its own criteria for determining the medical necessity of ABA therapy. Review your insurance plan carefully to see if your child meets the requirements for ABA therapy coverage.

Insurance Verification

Contact your insurance provider (call the number on the back of your insurance card) to determine coverage for ABA therapy. Most ABA providers can assist you with the insurance verification process. Insurance verification may involve understanding:

• Coverage Limits: How much your insurance plan covers medical expenses, including ABA therapy, annually.
• Deductible: The amount you must pay before your insurance policy starts paying for covered medical expenses, including ABA therapy.
• Copay: A fixed amount of money you pay for each ABA session or doctor visit.
• Provider Networks: If there are specific ABA providers within your insurance network.
• Prior Authorization: If pre-approval is required for ABA services (such as assessment and direct ABA therapy).

Provider Selection

Choose an ABA provider that fits your child and family well. Consider factors such as:

• Experience: The provider’s experience with children with autism.
• Therapist Qualifications: The qualifications and training of the therapists.
• Treatment Approach: The provider’s approach to ABA therapy.
• Family Involvement: The extent of family involvement in the therapy process.
• Accreditation: Accredited ABA providers adhere to the standards set by their accrediting organization.

Start looking for your ABA provider here!

Assessment

Before your child starts ABA therapy, the provider will conduct an initial assessment to determine their specific needs and develop a personalized treatment plan.

Note: The steps and duration of this process may vary depending on your location, insurance provider, and the specific ABA provider you choose.

It’s important to start the process early and work closely with your healthcare providers and the ABA provider to ensure your child receives the best possible care.