Does Amerigroup Cover ABA Therapy?

Amerigroup is a health insurance provider that offers coverage for Applied Behavior Analysis (ABA) therapy for children with autism spectrum disorder (ASD).

ABA therapy is an evidence-based treatment that can help children with autism improve their social, communication, and behavioral skills.

In this article, we'll discuss Amerigroup's coverage for ABA therapy in detail, including the eligibility criteria, coverage limits, and reimbursement process.

Eligibility Criteria

To qualify for ABA therapy coverage under Amerigroup, the child must have a diagnosis of ASD. The diagnosis must be made by a qualified healthcare professional, such as a licensed psychologist, psychiatrist, or developmental pediatrician.

The child's diagnosis must also meet the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Coverage Limits

Amerigroup's coverage for ABA therapy varies depending on the plan and state. However, in general, the coverage includes:

• An initial assessment by a Board Certified Behavior Analyst (BCBA) or a licensed psychologist to determine the child's individualized treatment plan.
• Ongoing ABA therapy sessions supervised by a BCBA or a licensed psychologist.
• Parent training sessions to help parents learn how to reinforce the skills their child learns during ABA therapy.

The coverage limits for ABA therapy may include the number of hours per week, the maximum number of sessions per year, and the age limit for coverage. For example, some plans may cover up to 40 hours of ABA therapy per week, while others may have a limit of 20 hours per week.

Some plans may also have a maximum number of sessions per year, such as 120 sessions per year. The age limit for coverage may vary by state and plan, but it is typically up to age 21.

Reimbursement Process

To receive reimbursement for ABA therapy, Amerigroup members must follow the following process:

1. Verify coverage: Check the member's plan to determine the coverage limits for ABA therapy.
2. Find a provider: Choose an ABA therapy provider who is in-network with Amerigroup.
3. Obtain preauthorization: Obtain preauthorization for ABA therapy from Amerigroup. This involves submitting the child's diagnosis and individualized treatment plan to Amerigroup for review.
4. Begin therapy: Once preauthorization is obtained, the child can begin ABA therapy.
5. Submit claims: Submit claims for ABA therapy to Amerigroup. Claims must include the provider's name, the date of service, the service provided, and the cost.
6. Receive reimbursement: Amerigroup will reimburse the member for the covered services, based on the plan's coverage limits.

Conclusion

Amerigroup's coverage for ABA therapy can provide much-needed support for families of children with ASD. By understanding the eligibility criteria, coverage limits, and reimbursement process, families can make informed decisions about their child's healthcare.

If you are an Amerigroup member and have a child with ASD, talk to your healthcare provider about the benefits of ABA therapy and how to obtain coverage.