Insurance is hard. Really hard. Between deductibles, copays, coinsurance, authorizations, networks, and EOBs, it can feel like you need a whole new vocabulary just to understand what your child’s care will cost. If you’ve ever looked at your insurance benefits and thought, “I have no idea what this means,” you’re far from alone. This guide breaks down the basics in plain language so you can feel a little more confident navigating insurance for your child’s ABA therapy.

💰 Know how your cost-sharing works. Your plan may use a copay or coinsurance for a particular ABA service. Check your benefits so you know what applies and when.

📅 Ask how often your copay applies. If you have a copay, ask whether it is charged per session, per day, or another way. This can matter when planning your child’s therapy schedule—for example, scheduling two separately billed sessions on the same day could mean two copays if your plan assesses one per session.

🔎 Always double-check network status. Confirm with your insurance plan that your chosen ABA provider is in network for your specific plan. Out-of-network care can cost significantly more, and many Medicaid managed care plans generally require families to use participating providers except in certain circumstances.

🗓️ Watch for the new plan year. Deductibles and out-of-pocket maximums generally reset at the beginning of your plan year—which isn’t always January 1. If your bill suddenly increases after a reset, this could be why.

✌️ Have two insurance plans? Tell your provider about both. Your ABA provider needs both policies so they can determine each plan’s requirements, including whether authorization is needed.

🔄 Don't forget Coordination of Benefits (COB). If your child has two insurance plans, make sure both insurers know about each other. Ask whether your COB information is current and confirm which plan is primary and which is secondary. Keeping this updated can help prevent avoidable claim delays and denials.

We are here to make complicated services a little easier to navigate. Send us the questions you're running into—from ABA authorizations and insurance to Medicaid, IEPs, and planning for adulthood—and we'll continue breaking down the information you need. Send us an email at: [email protected]