We are currently OUT OF NETWORK with: Blue Cross Blue Shield NC, Aetna, Cigna, Medicaid, and TriCare.

– North Carolina Autism Insurance Mandate

In the Fall of 2015, Governor Pat McCrory signed legislation that effectively provides coverage for autism services and treatment in North Carolina. This bill is called SB 676 and it went into effect on July 1, 2016. The mandate applies to insurance contracts that are renewed on or after this date. SB 676 includes coverage of Applied Behavior Analysis (ABA) and recognizes it as “a treatment that is considered the gold-standard of autism interventions.”  Coverage for ABA is given up for $40,000 per year and until the individual turns 18 years old.

Insurance plans that should cover ABA under SB 676 are:

  • Plans sold to employers with 100+ employees.

  • Plans sold to individuals and small groups that have been in effect and essentially unchanged since March of 2010.

  • Plans sold to individuals and small groups that are not grandfathers but were in effect prior to 2014.

Businesses that provide support for ABA services for their employees:

  • IBM: Special Care for Children's Assistance Program

  • Microsoft: Intensive Intervention for Children with Autism ABA Therapy Program

  • Cisco

  • NetApp

  • Wells Fargo

  • NC State Health Plan

  • Epic Games

What are the steps I should take to find out if my insurance plan will cover ABA services?

  1. Call your insurance provider and inquire as to what your plan covers for mental health services and Applied Behavior Analysis.

  2. IF you are eligible for coverage, ask your insurance company what to do. Typically the first step is making an appointment with the child's physician and getting a "prescription for services." This will be the doctor sending your insurance company the recommended services that are necessary to help your child reach their full potential.

  3. Once you get a "prescription for services," this will be sent to your health insurance provider. Then your insurance company will send you an authorization for services. The authorization will have the number of hours per service that the doctor has recommended.

  4. Give the authorization for services to your service provider. There is extra paperwork and forms that will need to be submitted monthly by the service provider in order for you to be reimbursed.

– Self-Funded Insurance

Many large corporations and companies’ insurance policies cover intensive behavioral therapy, like ABA. Employees of large corporations and companies should contact their employee handbook or talk with your Human Resources department to determine the details of your insurance plan and what autism coverage you may have. This is a link to a wonderful resource, provided by Autism Speaks. Click Here