Great News for Aetna Members!

Yes, Aetna covers ABA therapy based on your plan. 

Applied Behavior Analysis (ABA) therapy is a widely recognized treatment for individuals with Autism Spectrum Disorder (ASD). This therapy is crucial for improving communication, social skills, and learning behaviors in those with ASD. 

Aetna , one of the major health insurance providers in the United States, acknowledges the importance of ABA therapy and typically includes it in their coverage plans. 

Understanding the specifics of this coverage, particularly for residents of Maryland, can help families navigate their insurance benefits effectively.

Aetna provides coverage for ABA therapy as part of its behavioral health benefits. 

This coverage is generally considered a medical necessity for treating ASD , which means that most Aetna plans include it. 

However, the details of coverage can vary based on the specific insurance plan. Some plans may require pre-authorization or have limitations on the number of therapy sessions covered annually​.

To qualify for ABA therapy coverage under Aetna, a formal diagnosis of ASD from a qualified healthcare provider is necessary. Following this diagnosis, a detailed treatment plan must be submitted, outlining the specific therapy goals and objectives. 

This plan usually needs to be approved by Aetna before therapy can begin. The insurance provider may also require that the therapy be administered by a licensed professional with expertise in ABA​

Navigating the approval process for ABA therapy under Aetna can be complex. It often involves ensuring that all necessary documentation is in order and submitted correctly. 

Families should work closely with their healthcare providers to prepare and submit the required paperwork. 

Additionally, understanding the specifics of one’s insurance plan, such as session limits and out-of-pocket costs, is crucial. It’s recommended to contact Aetna directly or consult the policy documents to clarify these details​

While Aetna covers ABA therapy, there may still be out-of-pocket costs or coverage limitations. Families can explore additional resources such as state Medicaid waivers or financial assistance from non-profit organizations to help offset these costs.

Our team at All Star ABA Therapy is available to assist families in understanding and navigating their insurance benefits, ensuring that they maximize their coverage and support their child's therapy needs​.