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Does Insurance Pay for ABA Therapy in Arizona?

When children are diagnosed with autism spectrum disorder (ASD), doctors usually recommend that they receive specialized applied behavior analysis treatment.

Also known as ABA therapy, it’s a science-based approach to learning that helps children with autism build the social, communication and daily life skills with which they tend to struggle. As the leading treatment option for children on the autism spectrum, ABA therapy also teaches children how to modify certain behaviors that may be harmful and/or negative.

ABA therapy can be quite intensive, requiring as many as 40 hours per week of treatment for some children. This not only requires a significant time commitment but also a monetary one as well.

If you’re living in Arizona and have a child with autism, you may be wondering how you’re going to pay for their ABA therapy.

In this article, we’ll discuss whether insurance pays for ABA therapy in Arizona.

Key Takeaways
Arizona mandates ABA therapy coverage under HB 2847 for many insurance plans.
Children under 17 with ASD are eligible if their insurance plan is subject to the law.
Coverage limits are $50,000/year for children under 9 and $25,000/year for those aged 9–16.
Some insurance plans (like grandfathered or ACA-exempt plans) are not required to cover ABA.
A formal diagnosis and letter of medical necessity are required to access insurance-covered ABA therapy.

Table Of Contents

Does Arizona Mandate ABA Therapy Coverage?

In 2008, Arizona passed a state law that mandated meaningful coverage for autism-related services by state-regulated insurance plans. That law, called HB 2847, went into effect at the end of June in 2009.

The bill applies to all state employee health plans, individual plans subject to the Affordable Care Act, fully insured large group plans and fully insured small group non-grandfathered plans.

The only types of insurance not required to adhere to the law are individual plans specifically exempt from the ACA and fully insured small group grandfathered plans.

Insurance Plan Type Required to Cover ABA Therapy?
State employee health plans ✅ Yes
ACA-compliant individual plans ✅ Yes
Fully insured large group plans ✅ Yes
Fully insured small group (non-grandfathered) plans ✅ Yes
Individual plans exempt from ACA ❌ No
Fully insured small group (grandfathered) plans ❌ No

What Services Does Arizona’s Law Cover?

Under the law, insurance companies must cover the cost of an ASD diagnosis as well as behavioral therapy services, which includes ABA therapy.

There are some limits on that coverage, though.

To be covered under Arizona’s law, a child must have ASD and be less than 17 years old. Children under the age of 9 can qualify for up to $50,000 per year of coverage, while children between 9 and 16 can qualify for $25,000 per year of coverage.

The important thing to keep in mind is that these are minimum limits. Insurance carriers do have the choice to provide more coverage than this if they would like to — both in terms of an annual dollar amount or extra services.

If you want to know exactly what services and limits apply to you and your child, it’s best to reach out directly to your insurance company to find out more information. Every insurance company and plan is different.

What Do You Need to Do to Get ABA Therapy Covered By Insurance?

Again, each insurance company may have different policies or procedures you have to follow to get your child’s autism-related services covered by insurance in Arizona.

Generally speaking, though, you must first get an official ASD diagnosis for your child from a trained professional such as a developmental pediatrician, clinical psychiatrist or other professional. They must then write a letter of medical necessity that states ABA therapy is necessary for your child as a result of their ASD diagnosis.

Once you have these in hand, you must pick an ABA therapy provider that is in your insurance policy’s network. Then, you can start the process of applying to that facility and getting initial evaluations completed.

Your insurance company may require prior authorization for the services, which most of the time includes the ABA therapy clinic submitting the treatment plan and documenting why it is necessary.

Even after the services are approved, your insurance company may require a re-authorization down the line at regular intervals to ensure that the ABA therapy is still medically necessary for your child.

Blue Gems ABA Works with Many Insurance Providers in Arizona

ABA therapy can be quite the time and financial commitment. Luckily, most insurance companies in Arizona provide coverage for ABA therapy and some other autism-related services.

At Blue Gems ABA, we work with most insurance companies in Arizona, making it easier for families of children with ASD to afford the necessary treatment. We have plenty of experience crafting personalized treatment plans that not only get approved by insurance by help your child make great strides in their development.

To learn more, please contact us today.