Referrals
Some Cigna plans require a referral from your pediatrician or primary care provider, while others allow direct access to ABA therapy.
Diagnosis
Network status and benefits can differ based on your state or region, even within the same insurance company.
Prior Authorization
Most plans require prior authorization and documentation of medical necessity before therapy begins. We handle this process for you.
Session limits and costs
Coverage limits, copayments, coinsurance, and deductibles vary by plan. Some plans offer unlimited sessions; others have annual caps.
TriCare West
- TRICARE West
- TRICARE West Region (Administered by Health Net Federal Services)
- TRICARE Prime
- TRICARE Select
- TRICARE Select (West Region)
- TRICARE Prime Remote
- TRICARE Prime Remote for Active Duty Family Members (TPRADFM)
- TRICARE Young Adult (Prime Option)
- TRICARE Young Adult (Select Option)
- TRICARE Open Access (Behavioral Health)
- TRICARE West Region – Health Net Federal Services (HNFS)
- TRICARE Reserve Select
- TRICARE Retired Reserve (Family Eligible)
- TRICARE for Active Duty Family Members (ADFM)
- TRICARE West Autism Care Demonstration (ACD)
- TRICARE Extended Care Health Option (ECHO)
- TRICARE West Behavioral Health Network
- TRICARE West – Civilian Provider
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In most cases (with some exceptions, such as Colorado Medicaid), insurance plans require a formal diagnosis of Autism Spectrum Disorder (ASD) from a qualified provider—such as a developmental pediatrician, neurologist, psychologist, or psychiatrist—before ABA therapy can be covered. Without this diagnosis, insurers typically do not consider ABA therapy medically necessary.
Almost always. Prior authorization means your insurance company must review and approve the treatment plan before services can start. Our team handles this process for you, submitting the necessary clinical documentation to ensure approval.
Yes. Insurance companies require documentation showing that ABA therapy is medically necessary for your child’s development. This is usually demonstrated through the diagnostic report and a treatment plan written by a BCBA outlining specific, measurable goals.
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Approval times vary by insurer, but typically range from 1–3 weeks after all documents are submitted. Delays can occur if additional information is requested. Our team stays in close contact with your insurance to help move the process along.
Yes, most plans include coverage for caregiver training as part of the ABA treatment program. These sessions are considered essential because progress is greatest when parents and caregivers are part of the learning process.
Many insurers do cover telehealth ABA sessions, especially for parent training or supervision by a BCBA. Coverage may depend on your state and specific plan. We can confirm eligibility during your benefits check.
If your plan excludes ABA or limits coverage, we’ll walk you through alternatives—such as appealing the denial, switching to a plan with autism benefits, or exploring private pay or grant options. Some states also offer Medicaid or autism mandates that ensure ABA coverage.
