Insurance, in plain words.

01The basics of insurance coverage for ABA

ABA — applied behavior analysis — is the evidence-based therapy at the heart of autism care, and it has been an insurance-covered medical service in all fifty states since the early 2010s. That coverage came from two directions at once: state autism insurance mandates passed across the country, and the Affordable Care Act's designation of behavioral health as an essential health benefit.

Today most commercial plans — Aetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield — cover ABA under their behavioral health benefits. And Medicaid covers ABA in every state we serve through state-specific programs: Florida's Statewide Managed Care, Colorado's Health First, and Maryland Medicaid. Coverage is the rule now, not the exception.

What surprises most families is that most insurance plans do cover ABA therapy. The hard part is rarely whether you are covered — it is understanding the details. Every plan is different, and we walk you through every step so you know exactly where you stand.

02What 'in-network' really means

In-network means we have a contract with your insurance carrier that sets the rates and procedures for how care is delivered and billed. Out-of-network means we deliver the exact same therapy, but your insurance plan may have a higher out-of-pocket cost, deductible, or coinsurance — or sometimes it can even be lower than in-network coverage. It really depends on the specific plan. We walk you through every step and explain everything clearly.

Our network status varies by state, because every carrier contracts state by state. A carrier we are in-network with in Florida may be a separate contract in Maryland. We list which carriers we are in-network with for each state in the state sections below, so you can find your specific situation.

If we turn out to be out-of-network with your carrier, that is rarely the end of the conversation. We can often still deliver care through an out-of-network benefit, a single-case agreement negotiated with your carrier, or family-friendly self-pay rates. When we verify your benefits, we tell you which path is the right one for your family — and what it will actually cost.

Same therapy, same therapist. The only difference in- vs out-of-network is who pays what — and we make that part clear before you start.

03Understanding prior authorization

Prior authorization — also called prior auth, PA, or pre-cert — is your carrier's pre-approval that ABA is medically necessary for your child before they will pay claims. It is a gate, not a wall, and getting through it is mostly about paperwork done right.

Prior auth requires two things: an autism diagnosis from a licensed psychologist, developmental pediatrician, or other qualified clinician, and a comprehensive assessment that we conduct showing how many hours of ABA your child needs and why. Together those establish medical necessity in the language the carrier needs to see.

The turnaround usually runs 14 to 30 days depending on the carrier. We submit the entire packet for you and follow up daily — you are not the one sitting on hold. We have done this thousands of times and we know each carrier's quirks.

Sometimes prior auth gets denied. It happens, and it is usually a documentation gap rather than a real 'no.' When it does, we appeal with additional clinical documentation, and appeals in our hands win more often than not — because we know exactly what each carrier wants to see the second time.

04How we handle benefits verification for you

The moment you submit step 1 of our intake form, our intake team starts working. We pull your eligibility, coverage limits, deductible, copay, and prior authorization requirements directly from your carrier — not from a guess or a generic chart.

Within hours we know exactly what your plan covers, what it does not, and what your out-of-pocket will be. Then we call you back the same business day and explain it in plain English — no portal to decode, no insurance jargon left untranslated.

We do this with no cost and no obligation, before you commit to anything. You walk away knowing your numbers whether you start with us or not. We would rather you make an informed decision than a fast one.

05What a typical authorization timeline looks like

Most families move from first call to first session in 14 to 30 days. The variance comes from three things: your insurance carrier, your state, and whether you already have an autism diagnosis in hand.

Here is what a typical timeline actually looks like, step by step.

06Out-of-pocket costs explained

Four words cover almost everything you will be charged. Your deductible is the amount you pay before insurance starts covering costs. Coinsurance is your percentage share after the deductible. A copay is a flat fee per session. And your out-of-pocket maximum is the most you can be charged in a plan year — once you hit it, covered care is free for the rest of the year.

Medicaid families typically pay zero. Commercial families typically pay a small copay per session — often $10 to $40 — or coinsurance of roughly 10 to 30 percent until they reach their out-of-pocket max, and then nothing for the rest of the year.

Here is the part most families do not realize: ABA hits the out-of-pocket maximum faster than almost any other service, because session frequency is high — often 15 to 30 hours per week. Many families reach their max in the first quarter of the year and pay nothing for the remaining nine months.

We walk you through your specific numbers during verification, so the first bill is never a surprise. You will know your deductible, your per-session cost, and roughly when you will hit your max before you ever start.

07Florida Insurance Coverage

In Florida, we are currently in-network with Cigna, Aetna, and Curative First Health Network. We are not yet in-network with Florida Medicaid or any Florida Medicaid managed care plan, but we are actively working toward becoming in-network — submit your information and we will reach out as soon as Medicaid coverage is available.

We also work with many Florida families on an out-of-network basis through Florida Blue (BCBS), United Healthcare, and Tricare — out-of-network does not mean no coverage, it just means a different billing structure that we explain transparently before you commit.

Florida families may also qualify for the Step Up For Students Personalized Education Program, which provides up to $10,000 per child per year toward therapy and educational services. When both insurance and Step Up apply, we help families navigate them together.

08Colorado Insurance Coverage

In Colorado, we are in-network with Colorado Medicaid (Health First Colorado), Anthem BlueCross BlueShield, Cigna, and Aetna. We are not currently in-network with Colorado Medicaid managed care plans like Rocky Mountain Health Plans or Elevate Medicaid Choice — only with Health First Colorado directly.

We work with families on an out-of-network basis through United Healthcare and other carriers when in-network coverage is not available.

Colorado's prior authorization process is among the fastest of our states — most Colorado families move from first call to first session within 14 to 30 days.

09Maryland Insurance Coverage

In Maryland, we are in-network with Maryland Medicaid, CareFirst BCBS, Cigna, and Aetna. We are not currently in-network with United Healthcare or Tricare in Maryland.

Maryland Medicaid covers ABA for children up to age 21 through HealthChoice, the state's managed care system. Maryland also offers the Autism Waiver, which adds expanded services like respite care and family training — but the Waiver carries a long waitlist, often two to four years. Most Maryland families we serve use HealthChoice plans to start treatment in weeks, not years.

Maryland's prior authorization turnaround is typically 14 to 30 days.

10California Insurance Coverage

In California, House of Hearts ABA accepts Blue Cross Blue Shield, United Healthcare, Aetna, and Medi-Cal — covering families on commercial insurance plans and state-funded coverage across the entire state.

We are now serving California families statewide, from San Diego to Sacramento, with no waitlist. Our team handles benefits verification, prior authorizations, and payer communication directly, so insurance never becomes a barrier between your child and the care they deserve.

Not sure whether your specific plan is covered? Reach out and our team will look into your benefits at no cost to you before you make any decisions.

12Coverage across our four states at a glance

Coverage details current as of 2026 and subject to your specific plan. We confirm your exact benefits during verification.

14Insurance FAQ