As of April 2011, there are at least 31 states that mandate coverage for ABA therapy for certain health plans, and more states are coming on board each year.
If you live in one of the states that does not mandate coverage (or if your plan is not subject to the state mandate) and you have received a coverage denial or claim rejection, you can appeal this decision. Contact your insurance company to find out how their appeal process works. Some families have appealed and won. There's a chance you could be one of those families and we are happy to assist!
In most cases, you must have a prescribed treatment plan of care letter written by a physician to submit to your health insurance company. A pediatrician, developmental pediatrician, psychiatrist, psychologist or neurologist may be able write a plan of care for your child.
The plan of care must include certain keywords: Autism is a “neurological condition,” your requested services are “medically necessary,” and the treatment plan is labeled as a “treatment plan.” In addition, the treatment plan should be on the physician’s letterhead.
Please note that the sample below is just an example, and your physician will create one specific to your child: