How do I know if my child needs ABA therapy?

If your child is being treated for autism or developmental disabilities, chances are he or she can greatly benefit from ABA therapy. The decision to pursue it rests solely in your hands, and we invite you to contact Comprehensive to learn more and schedule an in-home assessment. To learn about the most common symptoms, click click here.

What can I expect to pay for ABA therapy?

Very little co-payment. Comprehensive is recognized by most insurance carriers offering either coverage or reimbursement. To learn more, please visit our Insurance section.

What is the process to sign up for ABA therapy?

It starts with one phone call to Comprehensive. The ideal method for developing a fitting program for your child is to have one of our board-certified BCBAs visit your family at home. Once we assess your child’s needs, we’ll guide you through therapy scheduling and administration. Click here to apply.

Where is CBS located?

Comprehensive provides ABA therapy and related services to families across the entire states of New York and New Jersey.

How many hours a week do most children receive ABA services?

Based on research, Comprehensive implements 15-25 hours per week to effect a tangible difference in your child's progress and retention of critical skills. Thereafter, your child can easily apply the skills learned to other settings throughout the home and beyond.

Does Comprehensive provide ongoing child supervision?

Our BCBAs supervise while our highly skilled aides execute your child’s treatment plan. Parent involvement is also a conduit for greater success, which is why we create a collaborative environment of care.

AComplete Resource Guide to Autism

Call us toll-free: 1-866-222-1111
Email us: [email protected]

Insurance Requirements for ABA Therapy Authorizations
In-Network (INN) vs. Out-of-Network (OON)
Key Insurance Terms
Ongoing Requirements after Initial Authorization
Navigating Insurance Challenges
Additional Tips
Accepted Insurances

Navigating insurance for ABA therapy can feel overwhelming. This guide explains key terms, coverage requirements, and the differences between in-network (INN) and out-of-network (OON) services.

Insurance Requirements for ABA Therapy Authorizations

Insurance plans often have specific requirements for approving and maintaining ABA therapy coverage, including:

ASD Diagnosis: A formal autism diagnosis is necessary. Some insurances require this evaluation to be updated every 5 years.
ABA Therapy Recommendation: Documentation from M.D, D.O, or PhD, stating that they recommend ABA Services.

In-Network (INN) vs. Out-of-Network (OON)

The type of network status impacts your costs and access to providers:

In-Network (INN)

Definition: Your provider has a contract with your insurance company.
Benefits:

Typically lower costs.

Insurance processes claims directly with the provider.

Providers are credentialed with the insurance, ensuring compliance with insurer requirements.

Limitations: You may have fewer choices of providers due to network restrictions.

Out-of-Network (OON)

Definition: Your provider does not have a direct contract with your insurance.
Benefits:

Greater flexibility in choosing providers.

Limitations:

Typically higher patient responsibility costs for services.

Insurance Carriers will also often submit payment to you and it will be your responsibility to pay your ABA Provider.

Key Insurance Terms

Insurance benefits typically renew once a year, either by the calendar year or at your workplace’s open enrollment period. Understanding the financial responsibilities involved in accessing ABA therapy is crucial.

Terms to be aware of:

Copay: A fixed amount you pay per day of services (e.g., $25 per session).
Deductible: The total amount you must pay out of pocket before your insurance starts covering services. For example, if your deductible is $2,000, you are responsible for paying 100% of the costs up to that amount.
Coinsurance: A percentage split of costs between you and your insurer. For instance, an 80%/20% split means your insurance covers 80%, and you pay the remaining 20%.
MOOP (Maximum Out-of-Pocket): The yearly limit you’ll pay for covered services. This includes all your copays, deductibles, and coinsurance payments. Once you reach your MOOP, your insurance will cover 100% of additional costs for the year.

Ongoing Requirements after Initial Authorization

Re-assessments: Every 6 months, reassessments are done to ensure progress is being made and to update the treatment plan with new goals. Insurance will re-authorize hours for your child if continued services are medically necessary.
Family Training: Insurance companies require family training to ensure therapy strategies are implemented consistently.
Direct Care Hours: The number of hours that are clinically recommended by your BCBA based on the level of care needed to carry outcomes. This must be supported by the treatment plan and approved by the carrier.
BCBA Supervision/BTM: BCBAs must supervise/give direction to your Behavior Technician at a 10:1 ratio of hours weekly to ensure progress and compliance with the treatment plan. BTM or Behavior Treatment Modification is also provided by the BCBA at a 10:1 ratio. If your child is receiving 20 hours a week of ABA, your BCBA is supervising your behavior technician for about 2 hours and is providing you training for 1 hour a week.

Navigating Insurance Challenges

Confirm Benefits: Always check with your carrier (or with our team) regarding ABA coverage details, including INN and OON benefits.
Track Spending: Monitor your out-of-pocket costs (copays, deductibles, coinsurance) to understand when you may reach your MOOP.
Ask Questions: If you’re unsure about any requirements, reach out to our intake department or insurance provider for clarification.
Self-Funded Plans: If your employer is providing you with insurance coverage, chances are you have a self-funded plan. Because self-funded plans do not always follow the state mandates for ABA coverage, it is important to have on hand your policy handbook that we can review to confirm your ABA coverage.

Additional Tips

Familiarize yourself with your plan’s renewal timeline to avoid lapses in coverage.
Consider reaching out to an insurance care manager for assistance if you encounter challenges.
If you have upcoming insurance carrier or policy changes, please ensure you notify your ABA Provider in a timely manner. This is to ensure that 1. Your child is covered for ABA on your new plan and 2. Your child will not have a lapse in service and all your ABA Authorizations can be transitioned over to your new plan.

Accepted Insurances

Disclaimer: this information is subject to change due to the nature of insurance policy adjustments. Please be in touch with an insurance advisor for guidance.

We are currently In Network with the following commercial plans:

Affinity
Aetna
Cigna
Emblem Health
Fidelis
HealthFirst
Horizon BCBS
MagnaCare
MetroPlus
MVP
Northwell Direct
NYSHIP
Oscar
Oxford
The Empire Plan
UMR
United Healthcare

We are currently In Network with the following Child Health Plus Plans https://nystateofhealth.ny.gov/

Affinity CHP
Fidelis CHP
Emblem CHP
Empire BCBS CHP
Healthfirst CHP
MetroPlus CHP
MVP CHP

We are currently In Network with the following Medicaid Managed Care Plans https://nystateofhealth.ny.gov/ Note, there may be a waitlist for Medicaid credentialed BCBA