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Navigating ABA insurance coverage for your child or teenager with autism spectrum disorder (ASD) in Tennessee can be confusing and overwhelming for many families experiencing the process. Additionally, rising autism prevalence rates mean more families are seeking services than ever. Fortunately, in Tennessee, meaningful coverage for autism services under state-regulated insurance plans is a requirement.
In such states, essential services for ASD, like evidence-based Applied Behavior Analysis (ABA) therapy, receive ABA insurance coverage for many families with a loved one who has an autism diagnosis because ABA therapy is considered a medical necessity for those living with the condition.
Programs like TennCare, TRICARE, autism grants, Autism Speaks, and other sources in Tennessee additionally help provide ABA insurance coverage to help qualified families who may not have private plans.
Today, ABA therapy is the industry’s golden standard in autism care, with years of established research demonstrating its efficacy in supporting those with ASD living with some of its more complex features, including maladaptive behaviors not limited to but including self-harm, hitting, or outbursts, to name a few challenging behaviors many families face daily.
The unfortunate reality is having a family member diagnosed with autism is often expensive beyond the complicated behaviors it can present. According to Autism Speaks, on average, many ASD families face a lifetime of costs between 1.4 million to 2.4 million dollars supporting their loved ones on the autism spectrum and offering them the best lives possible, which makes access to critical services like ABA vital.
This blog post by ABA Centers of Tennessee provides an overview of ABA insurance coverage within the state to ensure your loved one receives the ABA care they need to flourish and make significant developmental gains across their lifespan. We aim to provide you with everything you need to know to ensure you can secure the ABA insurance coverage you need without worrying about costs or potential financial setbacks, helping you focus on your family and your loved one’s developmental journey with ABA therapy.
So, let’s jump into this overview of what caregivers need to know about ABA insurance coverage in Tennessee to get the most out of their loved one’s ABA therapy!
Click here for more information about ABA therapy with ABA Centers of Tennessee or to read other helpful ABA and autism blogs.
How Does ABA Therapy Support Families with Autism in Tennessee, and Why is ABA Insurance Coverage Critical?
ABA therapy is a compassionate, behavioral approach to autism care that tailors to the needs of families and individuals experiencing neurodiversity. ABA helps many on the spectrum to improve and address rigid behaviors and social communication deficits while acquiring skills necessary for daily living. Additionally, ABA therapy helps individuals with ASD highlight their passions and refine their talents so they can participate in their lives in more significant ways.
Over time, ABA helps individuals establish the required skill sets so they and (their families) can function and more fully thrive in mainstream or community settings. ABA interventions are always scientifically validated to enhance the client’s quality of life and care while ensuring therapy helps them achieve what’s most meaningful and generally useful for their goals and personal lives.
The aim of ABA therapy is never to produce a neurotypical or rote child but to spotlight their inherent strengths while helping them feel empowered. ABA interventions can vary, often including techniques like discrete trial training, behavior chaining, and positive reinforcement to improve daily outcomes while keeping therapy sessions fun and rewarding.
If your child or teenager has received an autism diagnosis, your pediatrician or medical provider will likely recommend ABA therapy to help them reach their optimal potential and manage their condition’s challenges. Best of all, when utilizing ABA therapy, families watch their loved ones establish new routines and achieve greater independence while being engaged in sessions.
Is ABA Therapy Covered by Insurance in Tennessee?
As previously described, Tennessee mandates meaningful coverage for autism services under state-regulated insurance plans. This means most insurance plans cover ABA therapy, including private insurance providers or state programs such as TennCare and TRICARE, for families in Tennessee.
Under previous mandates, ABA did not receive coverage or financial aid. In 2019, the Tennessee Department of Commerce and Insurance presented a bulletin mandating insurance providers cover necessary care for neurodiversity, including ABA therapy.
These autism-specific benefits ensure insurance coverage for ABA is available to children under twelve with a diagnosis in the state. Under the Tennessee Autism Insurance Reform Update, fully insured individual plans, large group plans, and small groups must comply with these ABA coverage requirements.
The bulletin issuing these critical changes to ABA insurance coverage prohibits restrictions on treatment hours that were previously notoriously limiting.
Advocacy has also expanded eligibility criteria for ABA therapy under TennCare. Today, federal employee health benefits plans, Tennessee State Employee Health Benefit Plans, and even self-funded health benefit plans cover ABA therapy services for autism. However, some limitations and specifications may still exist.
Does Medicaid Cover ABA Therapy in Tennessee?
TennCare, Tennessee’s Medicaid program, offers ABA coverage for eligible children up to 21 years old. No annual benefit limits for ABA care exist under TennCare coverage. However, sometimes, the number of prescription hours utilized weekly is limited. Additionally, licensed healthcare providers must prescribe the service to access therapy coverage. Furthermore, the treatment must always be subject to medical necessity. Moreover, TRICARE covers ABA therapy for beneficiaries with an autism diagnosis.
These programs help ensure ABA access to families without the challenges of financial strain, so they focus on what truly matters: the personal growth and progress of their child experiencing developmental difficulties.
Understanding Your ABA Insurance Coverage in Tennessee
Before beginning ABA therapy services in Tennessee, it’s best to investigate your ABA insurance coverage benefits regardless of your policy. Ultimately, understanding what is covered, how much, and when is vital. While insurance providers in Tennessee should offer ABA coverage, the specifics vary depending on your plan or circumstances.
When evaluating your coverage options, it’s essential to consider important variables such as:
- Scope of Coverage
- Costs of premiums and co-pays
- In-network providers under each plan
Communicating with Your Insurance Provider and ABA Agency Makes a Difference
When securing ABA insurance coverage, it is critical to remain proactive with the ABA agency of your choice and discuss your needs directly with your insurance providers whenever possible. Never hesitate to ask any questions or request clarification about claims or any requests they make.
Additionally, maintaining an open line of communication throughout the process of securing insurance coverage for ABA can significantly reduce any adverse incidents regarding billings or unexpected expenses. Be sure to discuss your long-term needs and goals with your insurance provider regarding the circumstances of your specific situation. Clear communication regarding ABA insurance expectations ensures that your insurer provides the necessary coverage and information to make the best selection for your needs.
Keeping authorizations, medical records, or referrals available as needed can also be helpful, as insurance providers or medical professionals may request them at any time. Lastly, try your best to keep records of all your communications with your insurer, including phone calls, emails, and other correspondence, so you can reference communications as you gather insight about ABA insurance coverage to make things easier later.
Getting the ABA Insurance Coverage Your Loved One Deserves Now
Ultimately, when navigating ABA insurance coverage in Tennessee, the goal should be to get the most out of your policy and maximize the benefit of ABA services for your loved one. Doing so ensures they receive the services they need to progress through life more seamlessly, leading to more positive experiences for everyone. Thankfully, ABA insurance coverage in Tennessee makes that more possible.
By being active and persistent, you can overcome barriers and secure your family’s ABA insurance coverage to ensure better future outcomes in ASD.
More About ABA Centers of Tennessee
ABA Centers of Tennessee understands that securing ABA insurance coverage can be a difficult obstacle to receiving the ABA care many on the spectrum benefit from. Fortunately, we can help you attain the ABA support you need for better experiences and interactions with your loved one.
Call us at (844) 423-9483 or click here if your family requires an autism diagnosis or ABA therapy in areas of Tennessee, including Hendersonville, Nashville, Madison, and or Brentwood.
Our experienced ABA professionals can walk you through each step of the insurance process, including helping you understand your ABA insurance benefits regarding any services you may need from us.
