Insurance & Payment at Auvia Behavior Centers
Helping every child access ABA therapy shouldn’t be complicated. At Auvia Behavior Centers, we guide families through insurance coverage, funding options, and payment processes every step of the way.
How ABA Therapy Coverage Works
ABA therapy is a proven method for helping children with autism. Coverage can vary depending on your plan:
Key Points:
State Requirements: Most states, including Texas, mandate coverage for ABA therapy. Restrictions may apply based on age, therapy hours, or yearly limits.
Employer Plans: Fully funded plans usually follow state rules and provide strong coverage.
Self-Funded Plans: These plans may bypass state rules, which can limit or exclude ABA coverage.
Marketplace/ACA Plans: Coverage varies—some plans provide full benefits, others partial or none.
Auvia Support:
We review your insurance to explain what’s covered and what’s not.
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Understanding the Cost of Therapy
The cost depends on your insurance and the recommended therapy hours:
Factors That Affect Cost:
Insurance Plan Details: Deductibles, co-pays, co-insurance, and out-of-pocket limits.
Therapy Hours: Weekly hours recommended by your BCBA based on your child’s needs.
How We Help:
Review diagnostic or assessment reports
Establish therapy hours per week
Verify your insurance benefits and provide a cost estimate
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Pre-Authorization Process
Most insurance providers require approval before therapy starts. Timeline: 1–2 weeks.
Steps:
Diagnosis Verification: Submit an official autism diagnosis from a licensed provider.
Assessment Approval: Get authorization for the initial ABA evaluation.
Ongoing Therapy Authorization: Submit the treatment plan for approval of regular therapy sessions.
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Insurance Terms Made Simple
Understanding insurance terms is easier with a quick guide:
Deductible: Amount you pay before insurance starts covering therapy.
Co-pay: Fixed fee per session.
Co-insurance: Percent of costs shared with your insurer.
Out-of-Pocket Maximum: Maximum annual cost; insurance pays 100% after that.
Exclusions: Services not covered.
In-Network vs. Out-of-Network:
In-Network: Lower costs with contracted providers
Out-of-Network: Higher costs; may require claim submission
Pre-Authorization: Insurance approval before therapy begins
Notice of Benefits (NOB): Summary of coverage, limits, and costs
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Potential Coverage Limitations
Even with coverage, there may be limits:
Age Restrictions: Some plans only cover children under a certain age.
Hour or Cost Limits: Annual caps on therapy hours or total cost (e.g., 40 hours/year or $30,000 max).
Plan-Specific Rules: Extra hours may require ongoing approvals.
If Your Plan Excludes ABA:
We help explore alternative funding options.
Discuss possible coverage adjustments with your employer.
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Tips for Communicating with Your Insurance Provider
Ask direct questions: confirm ABA therapy is included, not just autism coverage.
Keep detailed notes: record names, reference numbers, and call details.
Review annually: insurance plans may change each year.
Notify Auvia: let us know about insurance or employer changes so we can manage new authorizations.
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Important Note
Insurance coverage varies by plan and may change. Auvia Behavior Centers provides guidance but cannot guarantee payment. Always confirm benefits with your insurance provider.
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Supporting Families Every Step
At Auvia Behavior Centers, we help families:
Understand insurance coverage
Access grants and financial resources
Navigate payment options
Our goal: make sure cost is never a barrier to your child receiving the therapy they need.
Contact us today to get started!