Navigating Insurance Benefits

Arizona’s Autism Insurance Bill (HB2847)

• Effective July 2009, insurance companies will be obligated to provide coverage for evidence-based behavioral therapy, including procedures derived from Applied Behavior Analysis (ABA) such as Discrete Trail Training, Pivotal Response Training, intensive intervention programs and early intensive behavioral intervention.
• ABA coverage is available for individuals until the age 16 diagnosed with Autistic Disorder, Asperger’s Syndrome or Pervasive Developmental Disorder - not otherwise specified.
• All treatments must be medically necessary and the insurer may establish limitations on the number of visits.
• This law applies to large group employers (more than 50 people).
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To find out if your son or daughter is eligible for insurance benefits you should contact your insurance company (most likely the behavioral health division). At a minimum, ask the following questions.

Under the Arizona Autism Insurance Bill does your insurance plan:

• Cover in and/or out-of-network in-home, clinic based or community based Applied Behavior Analysis (ABA) providers?

• Require prior authorizations?  If so how can you get that?

• Have co-pay or deductible? If so what are the amounts?

• Require the provider to have any special licenses or certifications?

• Have a limit on the duration of a therapy session? How many sessions is the client allowed per year?

Please note: That receiving the answers to these questions does not guarantee coverage.