The Autism Insurance law in 2011 opened the door for behavior analysts to provide services with insurance coverage. Medicaid made it easier for us to be providers for their members in 2014 and expanded the realm of diagnoses we could treat . But so far it has been difficult to get private insurers to cover ABA for an individual with a diagnosis other than autism, even though we all know that the science of behavior analysis isn’t exclusive to autism! Indeed our practice scope is not diagnosis specific (per the BACB and Board of Medicine).
What can we do to change this?
Aetna Commercial Insurance like all payors issues clinical guidelines that define the medical necessity criteria for providers to treat people with a particular diagnosis.
Aetna’s Policy Number 0426 covers treatment for ADHD. It specifically includes: intensive behavioral intervention programs (e.g. applied behavior analysis [ABA], early intensive behavior intervention [EIBI], intensive behavior intervention [IBI], and Lovaas therapy). It also specifically includes the Adaptive Behavior Assessments and treatment codes (97151-97158).
A provider relations representative from Aetna Commercial Insurance recently confirmed that Licensed Behavior Analysts are included in the providers who can serve this population and that as providers, we should submit for pre-authorization to be reimbursed to treat Aetna Commercial members with an ADHD diagnosis.
At the time of this post, VABA does not know of anyone who has successfully attempted to get an authorization for ABA services for this population with Aetna. If you are in a position to provide this service, please send us feedback on your experiences with the process. – email to firstname.lastname@example.org
Best of luck and thank you for taking care of people in Virginia!