Insurance and Funding Options
in-network, funding grants and private pay options
01 · Maryland Insurance Law
Children that are at least 18 months of age until their 6th birthday may receive less than or equal 25 hours per week. Children passed their 6th birthday until their 19th birthday may receive less than or equal to 10 hours per week.
02 · Insurance Accepted
ABS is an in-network provider of ABA services under Aetna Insurance as well as TRICARE through the Autism Care Demo. ABS can provide ABA services out-of-network for other insurance companies.
03 · Other Funding
ABS accepts LISS (Low Intensity Support Services) funding, grants and private pay consumers as well at reasonable rates. Contact Us to discuss all options and for a break down of our service rates. Information about available grants are provided at the bottom of this page.
MARYLAND INSURANCE LAW
REQUIRES COVERAGE FOR AUTISM TREATMENT
In March of 2014, Maryland finalized its Bill that requires coverage for autism treatment. This Bill falls under a previously existing mandate for Habilitative Services. This mandate allows behavioral health treatment including applied behavior analysis to be covered. Children that are at least 18 months of age until their 6th birthday may receive less than or equal 25 hours per week. Children passed their 6th birthday until their 19th birthday may receive less than or equal to 10 hours per week. Additional hours may be given if deemed medically necessary and appropriate. For more information please go to http://www.pathfindersforautism.org/resources/understanding-insurance/autism-insurance-in-maryland.
INSURANCE ACCEPTED (IN-NETWORK)
We take Aetna! As an in-network provider with Aetna behavioral health, ABS is able to provide applied behavior analysis services. ABA services under Aetna require a letter of medical necessity. Please review http://www.aetna.com/healthcare-professionals/documents-forms/applied-behavioral-analysis.pdf to get additional information on medical necessity. In addition, members can call Aetna Behavioral Health at 1-888-632-3862 to get information on coverage for ABA services.
We accept Medicaid.
We take TRICARE! The TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) for all TRICARE beneficiaries diagnosed with an autism spectrum disorder. Qualifications to receive services include a current diagnosis by an approved diagnosing provider and referral and authorization. For additional information please go to http://www.tricare.mil/Plans/SpecialPrograms/ACD.aspx. You may also call 1-877-TRICARE (1-877-874-2273).
CareFirst BlueCross BlueShield
We take CareFirst BlueCross Blue Shield! CareFirst BlueCross Blue Shield is a new provider of ABA therapy. Therefore, if you would like more information, please call 1-855-444-3121.
United Behavioral Health
We take United Behavioral Health (UBH)/Optum! UBH/Optum operates one of the nation’s leading managed behavioral care organizations. For more information related to ABA coverage, please contact 1-800-888-2998.
We take Cigna! Contact Cigna’s Autism Specialty Care Management Team at 1-800-274-7603 for support and questions.
ABS can provide ABA services for other plans provided in the state of Maryland under the Habilitative Services Mandate. However, there may be additional costs associated.
LISS (Low Intensity Support Services) is a program designed to help Maryland residents who have a developmental disability or their family access up to $2000 for identified services and items to support identified needs. The DDA distributes LISS funding twice during the fiscal year (July 1–June 30), in two rounds (July 1-31 and January 1-31). Funds cannot be received during both rounds regardless if the full $2000 were received. This is not an income-based program; funds are distributed based on a lottery (unlike previous years when it was at a first come first serve basis). For further information, please visit the following link: http://dda.dhmh.maryland.gov/SitePages/liss.aspx
National Autism Association’s Helping Hand Program
NAA’s Helping Hand Program provides families with financial assistance in getting necessary biomedical treatments, supplements and therapy services for their child with autism. This program does not offer funds for respite care, fencing, trampolines, swingsets, trips to Disney World, etc. Funding is extremely limited. This program is intended ONLY for parents in DIRE financial need. Do not apply if your annual net income exceeds $50,000. Helping Hand grants are one-time grants, previous recipients may not re-apply. This grant will also pay your medical provider directly. For more information, please see the following link: http://nationalautismassociation.org/family-support/programs/helping-hand/
Act Today for Autism Grants
This organization’s mission is to fund effective treatments, assessments and needed life supports to those with Autism. There is no income requirement however, incomes below $100,000 per year are reviewed first. In addition, applications from families with multiple children with an Autism diagnosis are reviewed first. Typical grants awarded range between $100 – $5,000. For more information, please see the following link: http://www.act-today.org/act-today-grant-program.php
United Healthcare Children’s Foundation
These grants provide financial relief for families who have children with medical needs not covered or not fully covered by their commercial health benefit plan. This organization’s mission is to fill the gap between what medical services and/or items your child needs and what your commercial health benefit plan will pay for. For more information, please see the following link: http://www.uhccf.org/apply/learn-more-about-medical-grants/grant-application-criteria/
Rise for Autism
Rise for Autism is an organization that offers grant opportunities to assist families in providing therapy to their children. http://www.riseforautism.com/grants.html
ABS will accept private payment for ABA services from clients, their parents/guardians, or anyone else acting on their behalf. Rate sheet available upon request.
Questions about Coverage, Confused ?
Contact Us to learn more about funding options specific to your needs.