ABA Therapy Insurance Coverage with Anthem

We Handle the Insurance, So You Can Focus on Your Child

If your family is covered by Anthem, we’re here to make the process as easy as possible. ‍

We work directly with Anthem to handle all the paperwork, verify your coverage, and get your child into therapy quickly—so you can focus on your child’s progress and not on the insurance details.

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What’s Covered Under Anthem for ABA Therapy

Here’s what you can expect when using Anthem for ABA therapy. Coverage generally includes:

Comprehensive Behavioral Assessments
‍We confirm your benefits before therapy starts, so you’ll know exactly what’s covered and what to expect.

In-Home ABA Therapy
‍One-on-one therapy in the comfort of your home where your child feels most at ease. This is where ABA therapy happens most effectively, addressing communication, behavior, and life skills.

School-Based Support
‍Therapy that extends into your child’s school environment, ensuring the skills they learn at home carry over into the classroom and social settings.

Parent Training & Support
‍We equip you with the knowledge and skills to continue reinforcing therapy at home, ensuring your child’s progress is consistent and long-lasting.

Ongoing Monitoring & Adjustments
‍Regular tracking of your child’s progress with ongoing adjustments to the therapy plan to ensure continuous improvement.

Anthem’s ABA Therapy Coverage: What You Need to Know

Comprehensive ABA Coverage

Anthem plans typically cover in-home, school-based, and sometimes community-based ABA therapy for children diagnosed with autism.Most BCBS plans provide coverage for in-home therapy, school-based therapy, and sometimes virtual services for children with autism.

Pre-authorization

A formal diagnosis of ASD and pre-authorization are usually required for coverage to begin.

Provider Network

Anthem’s network includes a wide range of licensed BCBAs and RBTs. To maximize benefits, it’s best to use in-network providers.

Plan and State Variations

Coverage varies depending on your plan type (PPO, HMO, etc.) and state laws, so it’s important to confirm the details.

How Milestone Achievements Works with Your Anthem Plan

At Milestone Achievements, we simplify the process with Anthem. Here’s how we do it:

Reach Out to Us
Provide us with your Anthem plan details and child’s diagnosis, and we’ll start the verification process right away.

We Verify Your Benefits
We’ll contact Anthem to confirm your benefits and check what ABA therapy services are covered, including in-home therapy, school support, and any pre-authorization requirements.

We Handle the Paperwork
Forget about spending time on hold with customer service reps. We’ll take care of all the forms and submissions to Anthem, so you don’t have to.

Therapy Begins
Once your coverage is confirmed, we schedule your child’s first therapy session in your home, on your schedule.

Start the Process Today

Why Families Trust Milestone Achievements with Anthem

Here’s why families working with Anthem choose Milestone Achievements for their child’s ABA therapy:

No Surprises - We confirm your benefits before therapy starts, so you’ll know exactly what’s covered and what to expect.

We Handle the Details - We take care of all the paperwork, authorization, and claims submissions. No stress, no extra work for you.

Therapy in Your Home - ABA therapy that’s personalized to your child’s needs, delivered right where they’re most comfortable—in your home.

Frequently Asked Questions About Anthem Coverage

Does Anthem cover ABA therapy for children with ADHD?

Some Anthem plans do cover ABA therapy for children with ADHD if it's deemed medically necessary. We’ll verify your specific plan to check this.

What do I need to provide for Anthem to approve ABA therapy?

Anthem generally requires a formal ASD diagnosis, a treatment plan from a licensed professional, and pre-authorization to begin ABA therapy.

How much will I pay for ABA therapy with Anthem?

Coverage and costs vary by plan. Many families find ABA therapy is fully covered, but some may pay a co-pay or have a deductible. We’ll verify your benefits upfront so there are no surprises.

What happens if Anthem denies ABA therapy?

If Anthem denies coverage, we’ll assist with the appeal process. Additionally, we explore alternative funding options if necessary, ensuring your child gets the care they need.

How long does it take to get approval for ABA therapy?

Typically, it takes 7-14 days to get approval from Anthem after submitting all required documentation. We’ll keep you informed throughout the process.

Can I use out-of-network providers for ABA therapy with Anthem?

While in-network providers are preferred for full coverage, you can use out-of-network therapists. However, coverage may be reduced, and out-of-pocket costs will likely be higher.

What happens if my plan doesn’t cover all the ABA therapy sessions?

If your Anthem plan doesn’t cover all sessions, we will work with you to appeal or seek alternative funding. We can also discuss options for partial payment or sliding scale fees.

Let’s Get You Covered

Insurance should never be a barrier to your child’s progress. Milestone Achievements works directly with Anthem to ensure your child gets the therapy they need—without the confusion or delays. Let us handle the insurance details so you can focus on your child’s growth.