Our therapy services and programs are typically covered by insurance. The exception is self-insured policies, which require special permission and a single-case agreement.
The following insurance companies will cover our services:
- Blue Cross Blue Shield, Humana, Aetna, and United Behavioral Health
- We are contracted with Blue Cross/Blue Shield & Optim only
Most agreements with private insurance include the following:
- All deductibles are paid out-of-pocket (can range from $1K to $5K).
- Once deductible is paid, insurance typically covers 80% of the cost UNTIL
- The out-of-pocket maximum is met. Once this happens, services are typically covered at 100%.
- Differences between a co-pay and a co-insurance. The former is typically a flat fee ($20 per visit) where as a co-insurance is a percentage (20% of the cost of session). Both of these refer to the client/patient responsibility. Co-pays and co-insurances no longer occur once the out-of-pocket maximum is met.
According to the Illinois Autism Insurance Mandate (2008), all private insurance companies, state and federally mandated, are required by law to cover this service. The only exception is ‘self-funded’ policies. The Illinois Autism Insurance Mandate is a law passed in the state of Illinois in 2008 that requires insurance companies to cover this service. Prior to that, the insurance companies did not cover ABA therapy. This is a relatively new treatment for children with autism in that it has become a medical benefit for private insurance policies.