Does Insurance Cover ABA Therapy in North Carolina?

For most families, cost is one of the first questions about ABA therapy. The short answer: most major insurance plans cover ABA therapy for a child diagnosed with autism, but coverage varies. This guide explains how coverage usually works in North Carolina and how to find out exactly what your plan includes.

Plans Empire ABA accepts

Empire ABA accepts Medicaid and most major commercial insurance plans, including:

Medicaid health plans and LME/MCOs

• Alliance Health
• AmeriHealth Caritas
• Carolina Complete Health
• Healthy Blue
• Partners Health
• Trillium Health Resources
• UnitedHealthcare Community Plan
• Vaya Health
• WellCare

Commercial insurance

• Aetna
• BlueCross BlueShield of North Carolina
• Cigna Healthcare

Don’t see your insurance company? Give us a call and we’ll see if we can help.

What “authorization” means

Most insurance plans need to approve ABA therapy before it starts. This is called prior authorization. Usually:

1. A BCBA completes an assessment of your child.
2. The BCBA writes a treatment plan with goals and a recommended number of hours.
3. The plan is sent to your insurance for approval.
4. Your insurer approves a number of therapy hours for a set period. The plan is then reviewed and re-authorized as therapy continues.

At Empire ABA, our office team handles the authorization process for you and verifies your benefits before therapy starts. We’ll tell you exactly what’s covered so there are no surprises.

Why coverage varies

Even within the same insurance company, plans differ. Things that can affect your coverage include:

• Your specific plan type, such as Medicaid, a plan through your employer, or a marketplace plan
• Deductibles, copays and coinsurance, the share of the cost you pay
• The number of hours authorized for your child
• Your child’s diagnosis, since coverage usually requires an autism diagnosis

Questions to ask your insurance company

If you want to check before you call us, ask your insurer:

1. Does my plan cover ABA therapy for autism?
2. Is prior authorization required?
3. Do I have a deductible, copay or coinsurance for ABA?
4. Is there a limit on hours or visits?
5. Is Empire ABA in-network for my plan?

Write down the date, the representative’s name and a reference number for the call. Or skip the phone tree: our team will verify your benefits for you.

How many hours will insurance cover?

That depends on your child’s needs and what your plan authorizes. Most children receive somewhere between 10 and 25 hours per week. Your BCBA recommends hours based on the assessment, and your insurer approves them.

Next steps

Have your insurance card ready and contact us. We’ll check your coverage and walk you through what comes next. New to ABA? Start with what in-home ABA therapy is, or see the full step-by-step process.