Insurance


Texas is one of 39 states with mandates requiring health insurance carriers to cover applied behavior analysis (ABA) services for children with a diagnosis of autism spectrum disorder (ASD).  Fully-funded health insurance plans and Affordable Care Act health insurance plans are included in the mandate.  Self-funded health insurance plans may exclude benefits for ABA, however, some employers have voluntarily included benefits for ABA services in their employee’s self-funded plans.  Health insurance does not typically cover ABA services for children who are typically-developing or have diagnoses other than autism.  If you are a family without insurance coverage for ABA services, please contact us about grant resources, our sliding fee schedule, and payment plans.

 

We are in-network with the following providers:

  • Aetna
  • Blue Cross Blue Shield of Texas
  • Cigna
  • Magellan
  • Seton Insurance Company
  • United Healthcare
  • ValueOptions/TRICARE
  • Call to inquire about other carriers as we are actively working to be in-network with more health insurance carriers.

 

Complementary Verification of ABA Benefits

We verify eligibility and benefits for ABA services as a courtesy to all potential clients.  Our billing department determines your eligibility and benefits for ABA services by contacting your health insurance carrier.  Verification of benefits for ABA services does not commit potential clients to services through Baucom Behavioral.   To determine your eligibility and benefits for ABA services, complete the Benefits Verification Form below.

Benefits Verification Form

 

Medicaid and ABA Benefits

In July 2014, the Centers for Medicare & Medicaid Services (CMS) mandated that Medicaid cover medically-necessary services for individuals with ASD under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services statute.  ABA is a medically-necessary treatment for autism.  Although the mandate passed over 2 years ago, Medicaid does not include benefits for ABA services in Texas.  Currently, 16 states include coverage of ABA services for families with Medicaid.  By the end of 2016, an additional 7 states have plans to include coverage of ABA servcies for families with Medicaid— Texas is not one of those states.  As of 2017, 54% of the US (27 states) will still fail to offer mandated coverage of services for individuals with ASD who have Medicaid.  Since the mandate in July 2014, class-action lawsuits have been filed in Nebraska, Hawaii, Pennsylvania, Ohio, and Illinois to require the state to cover the mandated ABA services for Medicaid families.  For more information about Medicaid, ABA, and what you can do to secure medically-necessary ABA services for your child with ASD, reference this article.