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Obtaining ABA via Insurance
My son was diagnosed with Autism in November 2006, when he was almost three. At that time I knew so little about Autism and I never heard about ABA. We asked the insurance company a few times to see if any program related to Autism might be covered. The insurance company told us no program included ABA was covered since there is no cure for Autism and ABA is considered experimental. The insurance company even told us to go to the Regional Center or school district to ask for services. Early this year, I was very lucky to meet the mom who successfully got insurance coverage and developed this great website to help other parents. She gave me the hope and strength to fight with the insurance company again. After talking to the Human Resource department, we were surprised to find out that our insurance covered early intensive behavior intervention programs included ABA started in 2007. We contacted the insurance company right away and a case manager was assigned to us this time as we insisted. It is very important to have a case manager. We were still being told different stories before we got a case manager. After reviewing the qualification of the ABA service provider we selected, finally the insurance company agreed to authorize the service. Within a month, we started an intensive in home ABA program, which the school district could not provide.
The following are the abstracts of our Autism Benefits.
"Autism benefit provides coverage for Early Intensive Behavior Intervention programs and related interventions for employees and dependents with Autism and Autism Spectrum Disorders effective 1/1/07. This includes but is not limited to Applied Behavior Analysis (ABA) therapy programs."
"The autism benefit program is provided with the following primary diagnoses: Autistic Disorder, Childhood Disintegrative Disorder, Asperger's Disorders, Rett's Disorder and Pervasive Development Disorder."
"Benefits will be provided as part of the Medical and Behavioral Health Benefit Plan at 80% of the Health Plan's negotiated rate up to $30,000 annually with a $90,000 lifetime maximum. This does not apply to the plan's out-of-pocket maximum."
"Coverage for the autism benefit excludes tuition for school based programs for autism and autism spectrum disorders, any related supplies or equipment associated with the treatment of autism, and any services provided by non-eligible providers."
"Eligible providers include: providers who have met established qualifications such as a certified ABA provider; providers who perform services in consultation with certified ABA provider; clinically licensed professionals, such as select Doctorate and Master's prepared providers, trained to treat autism and autism spectrum disorders. In the event a Certified provider is not available, services may be rendered by a non-certified provider under the supervision of a certified provider."
(Note: In California, no ABA provider has the license what the insurance company asks for. It will be a plus if the ABA provider has BCBA. As long as the provider has many years' experiences and provides services to SD and Regional Center, it should be considered as a qualified service provider.)
My husband's company is the second company in the nation besides Microsoft provides coverage for Autism. Several employees in the company with autism kids got together and proposed this benefit plan to the company last year. After reviewing their requests, the company took action and we got the coverage at last. Although the coverage is still not perfect, it is a good start and will be a trend in the future. Don't give up any hope. With all our efforts, we can make mission impossible to be possible.
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Insurance Help for California Families 
