Does Cigna Cover ABA Therapy?

Does Cigna Cover ABA Therapy?

The short answer is yes, Cigna does cover ABA therapy. However, the coverage may vary depending on your plan and the state you live in. In general, Cigna covers ABA therapy for children with ASD who are under the age of 21. The therapy must be medically necessary and provided by a licensed healthcare professional.

It is important to note that Cigna may require pre-authorization for ABA therapy. This means that you will need to get approval from Cigna before starting therapy. Your healthcare provider can help you with the pre-authorization process.

What is Cigna?

Cigna is a health insurance company that provides coverage for medical and behavioral health services. They offer a variety of plans, including employer-sponsored plans, individual and family plans, and Medicare plans. Cigna is one of the largest health insurance companies in the United States, with over 180 million customers worldwide.

What Does Cigna Cover for ABA Therapy?

Cigna covers ABA therapy as a behavioral health service. This means that it is subject to the same deductibles, copays, and coinsurance as other behavioral health services. Your specific coverage will depend on your plan and the state you live in.

In general, Cigna covers up to 40 hours of ABA therapy per week for children with ASD who are under the age of 7. For children between the ages of 7 and 21, Cigna covers up to 25 hours of therapy per week. The therapy must be provided by a licensed healthcare professional who is trained in ABA therapy.

What Should You Do if You Want ABA Therapy?

If you or a loved one has ASD and you are interested in ABA therapy, the first step is to talk to your healthcare provider. They can help you determine if ABA therapy is appropriate and if it is covered by your insurance plan.

If you have Cigna insurance, you should also contact your insurance company to find out what your specific coverage is for ABA therapy. They can provide you with information on deductibles, copays, and coinsurance, as well as any pre-authorization requirements.

How to File an Appeal if Your Request for ABA Therapy Coverage is Denied by Cigna Insurance

While Cigna covers ABA therapy, there may be instances where your request for coverage is denied. If this happens, you have the right to file an appeal with Cigna. Here are the steps you can take to file an appeal:

1. Review your denial letter: If your request for ABA therapy coverage is denied, Cigna will send you a letter explaining the reason for the denial. It is important to review this letter carefully so that you understand why your request was denied.
2. Gather supporting documentation: Before filing an appeal, gather any supporting documentation that could help prove the medical necessity of ABA therapy. This could include medical records, evaluations from healthcare professionals, and treatment plans.
3. Contact Cigna: Call the number on your denial letter or contact customer service to initiate the appeals process. You will need to provide information about yourself, your insurance plan, and the reason for your appeal.
4. Submit your appeal: Once you have initiated the appeals process, you will need to submit a written appeal within a certain time frame (usually 60 days). Your written appeal should include a detailed explanation of why you believe ABA therapy is medically necessary and any supporting documentation.
5. Wait for a decision: After submitting your appeal, Cigna will review your case and make a decision within a certain time frame (usually 30-45 days). If they approve your request for coverage, they will notify you in writing. If they deny your request again, you may have additional options for further appeals or legal action.

It's important to note that the appeals process can be complex and time-consuming. Consider seeking assistance from an experienced healthcare advocate or attorney if needed to ensure that you have the best chance of success in obtaining coverage for ABA therapy through Cigna insurance.

Tips for Maximizing Your Coverage and Minimizing Out-of-Pocket Costs

If you have Cigna insurance and are planning to receive ABA therapy, there are a few things you can do to maximize your coverage and minimize your out-of-pocket costs. Here are some tips to keep in mind:

1. Choose an in-network provider: To ensure the highest level of coverage, it is important to choose an ABA therapy provider who is in Cigna's network. If you choose an out-of-network provider, you may be responsible for higher deductibles, copays, or coinsurance.
2. Check your benefits: Before starting ABA therapy, check your Cigna benefits to understand what is covered under your plan. This will help you avoid any surprises when the bill comes.
3. Get pre-authorization: As mentioned earlier, Cigna may require pre-authorization for ABA therapy. Make sure you get approval from Cigna before starting therapy to avoid any delays or denials in coverage.
4. Keep track of hours: To ensure that you are not exceeding the maximum number of hours covered by your plan, keep track of the number of hours of ABA therapy received each week.
5. Consider a flexible spending account (FSA) or health savings account (HSA): If your employer offers an FSA or HSA, consider using these accounts to pay for out-of-pocket expenses related to ABA therapy.
6. Review bills carefully: After receiving ABA therapy, review all bills carefully to make sure that they accurately reflect the services provided and that you are not being overcharged.

By following these tips, you can help ensure that you are getting the most out of your Cigna insurance coverage for ABA therapy while minimizing your out-of-pocket costs.

Conclusion

ABA therapy is a valuable treatment option for children and adults with ASD. If you have Cigna insurance, you may be able to get coverage for this therapy. However, it is important to understand your specific coverage and any pre-authorization requirements before starting therapy. Talk to your healthcare provider and your insurance company to get the information you need to make an informed decision about ABA therapy.