How Do You Navigate ABA Therapy Coverage with Tufts Health Plan?
Understanding ABA Therapy
Applied behavior analysis (ABA) therapy is a widely recognized and evidence-based treatment for autism spectrum disorder (ASD). ABA is a therapeutic approach based on the science of learning and behavior, designed to:
Help children with ASD develop and improve social, emotional, and independent living skills through positive reinforcement.
Support children in making connections between behavior and consequences, and apply what they learn during ABA sessions to real-life situations
Empower children to feel more prepared for social situations at home, in school, and in the community
ABA therapy is often recommended for children with ASD, and early intervention can lead to better long-term outcomes.
Tufts Health ABA Therapy Coverage
Tufts Health Plan acknowledges that ABA therapy may have benefits for children with ASD. Their coverage policies generally include ABA therapy as a behavioral health benefit. However, we recommend that caregivers review their Tufts Health plans to understand the extent of their ABA coverage. Key points to consider during the review process are:
Coverage details: Reviewing your Tufts Health policy documents or contacting their customer service team can help you to understand the specifics of your ABA therapy coverage, including deductibles, copayments, coinsurance, and any pre-authorization requirements.
In-network provider status: Your Tufts Health plan may include a network of preferred providers for ABA therapy services, and Cortica may be in that network. Utilizing in-network providers can often result in lower out-of-pocket costs for covered services.
Treatment authorization processes: Some Tufts Health plans may require you to receive pre-authorization for ABA therapy services. Understanding the steps for that authorization can help you to secure the necessary coverage for treatment.
Other coverage terms and conditions: Tufts Health may have other terms and conditions that apply to ABA therapy coverage, such as visit limits or requirements for treatment plans and progress reports
Cortica and Tufts Health
Cortica, a leading provider of comprehensive autism therapy services, accepts Tufts Healthcare insurance for ABA services. Cortica's team of experts is committed to using a naturalistic, play-based approach to ABA that is built around positive, caring relationships. Our ABA approach is tailored to each child’s needs and empowers children to learn new skills in everyday settings. With a focus on evidence-based practices and physician-led care, Cortica helps children with autism to reach their full potential.
Advocating for Coverage
If you encounter challenges, discrepancies, or claim denials regarding your ABA therapy coverage through Tufts Health, you have the right to advocate for your child's needs. Keep the following in mind: In some cases, a simple error may lead to a billing discrepancy or a denial of your insurance claim. This type of error can usually be cleared up with a phone call to your insurance provider. Before calling:
Make a list of questions you have about the issue
Gather all relevant information including your policy, the summary of benefits coverage (SBC), and any notifications from your insurance provider
Keep notes of all conversations you have with insurance company representatives, including information on the representatives that you speak with as well as the dates and times of your conversation. Ask for the representative’s direct number so you can contact them more easily in the future.
All insurance policies include information on the appeals process as well as associated timelines for the process. Review your policy for more information. If your insurer continues to deny your claim, be persistent and follow all instructions for appeal. Be sure to:
Give specific reasons why your claim should be paid under your policy, including why the treatment is necessary as well as any evidence that supports your claim, including medical records
Keep copies of all correspondence with your insurer
Contact your state’s department of insurance if you feel your insurer is not cooperating with the appeals process
