Little Leaves will support you in determining if you have insurance benefits for ABA and, if so, in accessing those benefits – including dealing with authorizations and billing.
Little Leaves is currently in network with:
- Anthem Blue Cross Blue Shield
- Carefirst Blue Cross Blue Shield
- Kaiser Permanente
- United Behavioral Health/Optum
We are also working with families who have:
- Blue Cross Blue Shield (from other states)
We continue to pursue relationships with other insurance companies, so check with us to see if we are in-network with yours.
Many health insurance plans now cover the treatment of Autism Spectrum Disorders (ASD), including ABA therapy. Even if your state has not implemented an“Autism Insurance Law”, you may have coverage through your private insurance or Medicaid. Autism Speaks has developed a page to help you determine if you have insurance coverage for the treatment of autism. We also provide information below.
All plans available to Federal Employees cover ABA as of 1/1/2017. Before choosing a plan, be sure to check the plan details carefully to understand the potential cost and treatment limits for ABA.
- Virginia state employees can have coverage for ABA as required by the Virginia Autism Mandate.
- Maryland state employees health plan participants have coverage for ABA under the Maryland mandate.
- DC employees do not currently have coverage in their plans.
Military / Tricare
Through the Comprehensive Autism Care Demonstration, ABA therapy is now available to all Tricare beneficiaries, both active duty and retired. Click here for more details.
Affordable Care Act (individuals and small group)
- VA: It is not currently possible to buy an individual plan in Virginia with ABA coverage.
- MD: Plans sold through the Maryland Health Exchange fall under the Autism Mandate and include coverage for ABA.
- DC: Some plans sold through the Washington DC health exchange for individuals and small groups contain an autism insurance benefit including coverage for ABA therapy.
- Please visit your state's exchange for more information. It is possible to purchase a child-only plan even if you have employer provided insurance.
Private Employer Sponsored Insurance
- Please check Autism Speaks to see if there is a mandate in the state.
- The best thing to do to determine if you have coverage for ABA therapy for the treatment of an ASD is to call your insurance company and ask, but here are some tips to make sure you are getting the right information.
- Determine if your group health plan is fully-funded or self-funded (aka self-insured). You can ask either your insurance company or your HR department.
- For self-funded plans: Ask your HR department or insurance company whether the policy contains an autism benefit. (There is a partial list of self-funded companies with autism benefits listed in the Autism Speaks Self-funded Employer Tool Kit.) Some large employers in our area with a benefit include The Washington Post Companies, Capital One, and Arnold & Porter.
- If the plan does not cover it, consider using the tool kit to approach your employer about adding an autism benefit.
- For fully-funded plan: Determine whether your policy is subject to a state autism insurance mandate.
- Ask your HR department or insurance company for the state in which the insurance contract was written and whether it is a small (50 employees or less) or large (more than 50 employees) group policy.
- Then visit Autism Speaks to determine if there is an autism insurance mandate in the state in which the contract was written, and whether it applies to a plan of your type. If your type of plan is covered under the law, your insurance policy must cover the mandated level of benefits. (Because this is based on where the contract is written, and not where you live, you may have coverage even if your state does not have an autism insurance law in place.)
- For private employer sponsored plans in our area:
- VA: There is an Autism Insurance Mandate which requires coverage for children between the ages of 2-6 years for large group insurance plans.
- MD: The Habilitative Services Mandate requires coverage for ABA for all children under the age of 19.
- DC: See the Afforadable Care Act section above.
- Note: the state of the plan is determined by the insurance contract between the employer and the insurance company, not the state in which you reside.
If your plan does cover ABA, you will most likely require pre- authorization for services. Contact us for help.
Note: unless you are speaking to a specific “ABA” department at your insurance company, be please skeptical of the information you are given unless you follow the instructions above. When coverage is not mandated by law, many plans, unfortunately, exclude coverage for ABA therapy.
No insurance coverage for ABA?
We know that intensive ABA services are expensive. But we also know that it is an investment in your child’s future. If you can afford to pay for them directly, please consider doing so. If you live in DC or MD, you may be able to purchase a policy for your child through the individual market / health exchange.
- Early intensive behavioral services change the trajectory of your child’s development
- Providing therapy to a child at a young age can significantly decrease the lifetime costs of caring for him/her. In fact, according to the Autism Society of America, “The cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention."