(908) 377-0282

Insurance for ABA Therapy

Does Insurance Cover ABA Therapy?

Often, yes. TEAM Behavioral Consultants works with Horizon, Aetna, United Behavioral Health, Optum, Evernorth, Amerigroup, Cigna, Medicaid and TRICARE for in-home and center-based ABA therapy, and we help NJ families check their insurance benefits before services begin.

Coverage depends on your specific plan — not just your insurance company. Two families with the same carrier can have very different benefits, deductibles and authorization rules, so the reliable answer for your family comes from a benefits check.

Our team is trained to explain insurance terms in plain language, verify what your plan covers and help you understand what therapy will cost before your child starts.

Verify My Benefits Financing Options

Insurance Plans We Work With

We work with the following plans for in-home and center-based ABA therapy:

  1. Horizon
  2. Aetna
  3. United Behavioral Health
  4. Optum
  5. Evernorth
  6. Amerigroup
  7. Cigna
  8. Medicaid (NJ FamilyCare)
  9. TRICARE

We accept Medicaid through some plans, so ask us about yours. If your carrier isn’t listed, contact us — we can still check your in-network and out-of-network benefits.

How Benefits Verification Works

Before therapy begins, we find out exactly what your plan covers and explain it to you.

  1. 1Share Your Plan Details
  2. 2We Check Your ABA Benefits
  3. 3We Explain Your Coverage
  4. 4Prior Authorization
  5. 5Therapy Begins

1. Share Your Plan Details

Call us at (908) 377-0282 or reach out through our contact page, and our team will tell you what information we need.

2. We Check Your ABA Benefits

We confirm whether your plan covers ABA therapy, what documentation it requires, whether prior authorization is needed, and your deductible, copay or coinsurance and out-of-pocket maximum.

3. We Explain Your Coverage

We walk you through what we found in plain language, including what you can expect to pay.

4. Prior Authorization

Most plans require authorization before ABA therapy starts, usually based on your child’s diagnosis and the BCBA’s assessment and treatment plan. Plans typically reauthorize services periodically as the plan is updated.

5. Therapy Begins

Once coverage is confirmed, your child’s services are scheduled. If your coverage changes — a new job, a new plan year — let us know and we will check again.

New Jersey’s Autism Insurance Mandate

New Jersey’s 2009 autism insurance law requires fully insured health plans regulated by the state to cover medically necessary applied behavior analysis for autism, along with autism screening and diagnosis and medically necessary speech, occupational and physical therapy.

Whether it applies to you depends on how your plan is funded:

  1. Fully insured New Jersey plans — including individual and family marketplace plans and many employer plans issued in New Jersey — must follow the mandate.
  2. Self-funded employer plans are governed by federal ERISA law, not state mandates. Many large employers are self-funded. These plans often cover ABA anyway, and federal mental health parity rules still apply.

Not sure which you have? Ask your HR department, call the member services number on your insurance card, or let us check for you. Autism New Jersey explains the mandate in detail.

NJ FamilyCare, Medicaid & TRICARE

Since April 2020, NJ FamilyCare — New Jersey’s Medicaid program — has covered medically necessary ABA therapy for members under 21. We accept Medicaid through some plans; contact us and we will tell you whether we can serve your child under yours.

TRICARE covers ABA therapy for military families through its Autism Care Demonstration, which has its own referral and authorization steps. We can walk you through them.

Out-of-Network Benefits

If we are not in network with your plan, your out-of-network benefits may still cover part of the cost. Ask us to check, and see our financing page for payment plan options.

Questions About Insurance

Which insurance plans does TEAM Behavioral Consultants accept?

We work with Horizon, Aetna, United Behavioral Health, Optum, Evernorth, Amerigroup, Cigna, Medicaid (NJ FamilyCare) and TRICARE for in-home and center-based ABA therapy. We accept Medicaid through some plans, and we can check out-of-network benefits for other carriers.

How do I know if my plan covers ABA therapy?

Ask us for a benefits check. We confirm whether your plan covers ABA, what it requires before services start, and your deductible, copay or coinsurance and out-of-pocket maximum — then explain it to you in plain language.

What is the New Jersey autism insurance mandate?

New Jersey's 2009 autism insurance law requires fully insured, state-regulated health plans to cover medically necessary applied behavior analysis for autism, along with screening, diagnosis, and speech, occupational and physical therapy. It does not apply to self-funded employer plans, which follow federal ERISA law, although many of those plans cover ABA too.

Does NJ FamilyCare (Medicaid) cover ABA therapy?

Yes. Since April 2020, NJ FamilyCare has covered medically necessary ABA therapy for members under 21. We accept Medicaid through some plans — contact us to find out whether we can serve your child under yours.

Do I need prior authorization for ABA therapy?

Usually. Most plans require prior authorization before ABA therapy begins, typically based on your child's diagnosis and the BCBA's assessment and treatment plan, and they reauthorize services periodically. We work with your plan through the process.

Can I use insurance for Kidz Connect social skills groups?

In some cases, yes. Whether insurance applies to Kidz Connect depends on your child's plan and circumstances. Our Program Coordinator can talk through pricing, payment and coverage options with you at kidz@teambehavioralconsultants.com.

Helpful Resources for Families

Financing ABA TherapyCosts, payment plans and HSA/FSA What Is ABA Therapy?The fundamentals, explained for parents Autism TreatmentHow we treat autism with ABA Our ServicesIn-home, center-based, school and Kidz Connect Family ResourcesAutism NJ, NJ FamilyCare and more Contact TEAMStart a benefits check

Talk With Our Team

Have a question about your child, or wondering whether ABA therapy is the right fit?

Share a few details and someone from our team will reach out to talk it through with you.

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Insurance Plans at a Glance

We work with the plans below for in-home and center-based ABA therapy. Coverage varies by plan, so ask us to verify your benefits. Ask us about coverage for Kidz Connect.