Does Aetna Cover ABA Therapy in Nebraska?

Many medical and mental health professionals refer children with autism spectrum disorder (ASD) for applied behavior analysis. ABA therapy, as it’s also called, is considered the gold standard of treatment options for children with autism.

The science- and evidence-based approach to learning can help children build the social and communication skills that they often struggle with, while also learning to modify certain negative and/or harmful behaviors.

ABA therapy is often quite intensive, with multiple hours necessary over multiple days per week. Not only is this time consuming, but it also brings up the question of how much it’s going to cost.

If your child has autism, you may be wondering if Aetna covers ABA therapy in Nebraska. We’ll discuss that topic in more detail below.

Learn more about insurance coverage for ABA Therapy
Learn more about Insurance coverage for ABA Therapy in Nebraska

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Does Aetna Cover ABA Therapy in Nebraska?

Aetna is among the biggest insurance companies in the U.S. They provide coverage for millions of people across the country.

There are many different plans that Aetna offers, including self-insured and fully-insured plans. Most Aetna plans offer coverage for ABA therapy, but that depends on the type of plan that you have.

Fully-insured plans typically have to adhere to coverage requirements that individual states mandate for children with ASD, which includes ABA therapy. Self-insured plans may not have to comply with these regulations, though that doesn’t mean your child’s ABA therapy won’t be covered.

Plan Type	Coverage for ABA Therapy	Requirements	Notes
Fully-Insured	Must follow Nebraska state law	Diagnosis, medical necessity letter, possible pre-approval	More predictable coverage
Self-Insured	May vary	Same as fully-insured but not state-mandated	Check specific plan details carefully

As such, it’s very important to understand your specific insurance plan and whether it covers ABA therapy. Even if it does, you should also figure out whether there’s a limit to the coverage and what you must do to qualify for this coverage.

Category	Details
Insurance Provider	Aetna
State	Nebraska
ABA Therapy Coverage	Typically covered (depends on plan)
Plan Types	Fully-Insured: Must follow state mandates Self-Insured: May vary
Requirements	Child under 21 Official ASD diagnosis Letter of medical necessity
Pre-Approval Needed?	Often yes; depends on plan
In-Network Providers	Strongly recommended
Recommended Provider	Blue Gems ABA

How Can Your Child Qualify for ABA Therapy under an Aetna Plan?

Regardless of what type of coverage your insurance plan provides, Aetna will require a few steps before your child can qualify for ABA therapy. Your child will need to be fully enrolled in your Aetna healthcare plan first, and in many cases, they will need to be 21 years of age or younger to qualify for ABA therapy.

After those two requirements are met, the first step is getting an official ASD diagnosis. This can be done in many cases by a clinical psychologist, developmental pediatrician or another healthcare professional who’s trained in the field.

Once this diagnosis has been given, you need to obtain a letter from this provider that states that ABA therapy is a medically-necessary treatment plan. Since ABA therapy is so well-regarded today, it isn’t particularly challenging to explain to an insurance carrier that this treatment plan is the best path forward for your child.

Step	Action	Notes
1	Enroll in Aetna healthcare plan	Child must be under 21
2	Obtain official ASD diagnosis	From qualified professionals
3	Obtain letter of medical necessity	From diagnosing provider
4	Submit documents to Aetna	Include diagnosis and necessity letter
5	Get pre-approval (if needed)	Ensure ABA provider is in-network
6	Start therapy sessions	Monitor coverage limits

Does ABA Therapy Need to Be Pre-Approved?

At this point, Aetna will likely approve your child’s ABA therapy, and will advise you as to what the allowable coverage will be. This could include a certain number of hours per week, per month or per year, or a maximum dollar amount that they will cover in a given time period.

Depending on the Aetna plan that you have, you may need to have your child’s ABA therapy pre-approved before you can schedule it. If this is necessary for your plan, Aetna will likely need to approve the ABA therapy provider you choose, as well as the treatment plan that they create for your child.

It’s very important that you choose a reputable ABA therapy provider that is in your Aetna network. If you don’t, you run the risk of your child’s treatment sessions not being covered by your insurance plan, which could lead to high out-of-pocket costs on your end.

The good news is that when you work with an experienced ABA provider such as Blue Gems ABA, you’ll be gaining peace of mind that their professionals know exactly what is needed to get your child’s treatment plan and sessions approved by your insurance company.

Blue Gems ABA Works with Aetna Plans in Nebraska

ABA therapy is a tried-and-true treatment plan for children on the autism spectrum. Through repetition, positive reinforcement and many other strategies, your child’s therapist can help them gain the skills that they need to live a happy, healthy, productive, fulfilling and independent life.

At Blue Gems ABA, we have a team of experienced therapists who work with patients on a one-to-one basis, crafting ABA therapy plans that are catered specifically to each individual’s unique strengths and challenges.

We work with all types of insurance plans in Nebraska, including Aetna, to make it easier for families like yours to afford this support.

To learn more, please contact us today.