Does Insurance Cover Autism Therapy in Georgia?

How to Navigate Insurance Coverage for ABA, Speech and Occupational Therapy in Georgia

For caregivers, understanding insurance coverage for pediatric therapy services in Georgia can feel overwhelming. Insurance plans vary widely, and knowing what your specific plan covers is essential for accessing the necessary services and support for your child.

Hopebridge is here to help. In this piece, our Hopebridge Care and Benefits team dives into some of the most common questions related to insurance coverage for ABA therapy in Georgia, speech therapy in Georgia, and occupational therapy in Georgia.

What specific autism services does the insurance plan cover?

The coverage for autism services varies by insurance plan, so it’s important to review your policy carefully. Many plans cover autism evaluations, therapeutic interventions like applied behavior analysis (ABA), occupational therapy, and speech therapy, and other related services. When reviewing your plan’s benefits, look for information related to behavioral health or mental health services, which is where child development and autism-related coverage is typically outlined. This can usually be found in the Member Handbook or Evidence of Coverage (EOC) issued by your health plan.

Are diagnostic evaluations for autism spectrum disorder (ASD) covered by the insurance?

Diagnostic autism assessments are often a crucial first step in the journey of autism therapy. Many insurance plans provide coverage for autism testing, but coverage can vary depending on the plan type and provider network. For instance, some plans may not cover diagnostic testing, but do cover ABA services. It is important to confirm your individual plan’s requirements before scheduling an evaluation.

What types of therapies for autism are covered, such as ABA, speech therapy, or occupational therapy?

Coverage for pediatric therapies varies by plan. Commonly covered services include applied behavior analysis (ABA therapy), speech and language therapy, and occupational therapy. Review the policy for specific details on covered therapies, as well as any limitations or restrictions. Insurance companies often manage behavioral health benefits separately from physical health benefits, which means ABA therapy may have different requirements than speech or occupational therapy. Be sure to review your plan’s coverage details for each service individually, along with any authorization or documentation requirements.

What are the best insurance companies in Georgia for ABA therapy and other autism services?

Insurance companies offer a variety of plans, and families should select the option that best meets their needs. In Georgia, Hopebridge works with Aetna, Anthem BlueCross BlueShield, Cigna (Evernorth Behavioral), Georgia Medicaid, Humana, Kaiser Permanente, and UHC United Healthcare for coverage of ABA therapy.

How much is autism testing with insurance?

The cost to have an evaluation for an autism diagnosis depends on your insurance plan’s benefits, contracted rates, and cost-sharing structure. Hopebridge will bill the insurance company directly, and your child’s specific plan will determine any applicable deductibles, copayments, or coinsurance.

How much does ABA cost?

The cost of ABA therapy varies based on the type of services provided, the length of treatment, and your individual insurance benefits. Like diagnostic services, Hopebridge will bill your insurance on your behalf, and your child’s specific plan will determine any contracted discounts or out-of-pocket costs. Payment plans may also be available depending on your circumstances.

 

Is there a limit on the number of therapy sessions or hours covered per week or per year?

Some insurance plans place limits on therapy sessions or hours, while others base coverage on medical necessity rather than fixed caps. Fully insured plans in Georgia are generally required to cover autism services without arbitrary dollar or hour limits, as long as services are deemed medically necessary. Self-funded employer plans may follow different rules. Review your policy or speak with your insurance provider to understand how session limits are handled under your plan.

Are medications related to autism treatment covered by the insurance?

Hopebridge does not prescribe medication, but some children with autism may have medications deemed medically necessary as part of their overall care plan, particularly for co-occurring conditions such as anxiety or attention deficit hyperactivity disorder (ADHD). Coverage for Smedications falls under your pharmacy benefits rather than autism therapy benefits, so it’s important to review your prescription drug coverage separately.

Does the insurance cover assistive devices or tools that may benefit my child with autism?

Some insurance plans may cover assistive devices, such as AAC devices (communication devices), under durable medical equipment (DME) or assistive technology benefits. Coverage varies significantly by plan and typically requires medical necessity documentation. Sensory tools and similar items are often excluded for coverage. Check your policy to understand what types of devices may be eligible and whether prior authorization is required.

Are there any age restrictions for autism coverage under the insurance plan?

For fully insured health plans in Georgia, autism services are generally covered through age 21 without dollar limits when medically necessary, but certain providers may specialize in specific age ranges (Hopebridge serves up to age 10 for ABA and up to age 18 for speech and OT). Verify the age limitations specified in your policy to ensure continuous coverage for your child.

What Insurance Coverage for Autism Therapy Means for Your Family

Understanding the intricacies of insurance coverage for autism therapy in Georgia empowers parents to advocate effectively for their children. We recommend you regularly review your child’s policy, stay informed about any changes and communicate with your insurance provider to ensure that your child receives the comprehensive care they need. By being proactive, families can navigate the complexities of insurance coverage and provide the best support for their children on the autism spectrum.

To get autism testing and therapy support for your child, contact us at Hopebridge Autism Therapy Centers. Our Care and Benefits Coordinators will work with you to confirm your benefits and insurance coverage, obtain any necessary authorizations and inform you of any out-of-pocket costs. We’re here to guide you through the process so you can put your focus on your child and get them the extra care that they deserve.

*Informed consent was obtained from the participants in this article. This information should not be captured and reused without express permission from Hopebridge, LLC. Testimonials are solicited as part of an open casting call process for testimonials from former client caregivers. Hopebridge does not permit clinical employees to solicit or use testimonials about therapeutic services received from current clients (Ethics Code for Behavior Analysts 5.07-5.08; BACB, 2020). Hopebridge does not provide any incentives, compensation, or renumeration for testimonials provided by a former client or client caregiver.