Getting Started with ABA Therapy: Insurance, Timeline, and Process
Starting ABA therapy shouldn't be complicated. At Achieving Stars Therapy, we handle insurance authorization, conduct the initial assessment, and begin services within 1-14 days of receiving your completed intake packet. No waitlist. No delays.
Most families pay nothing out of pocket if they have Medicaid coverage (primary or secondary). Private insurance typically covers ABA therapy with a deductible or copay depending on your plan. We verify benefits during intake so you know exactly what to expect before services start.
This page walks through the entire process: what documents you need, how insurance works, what happens during the evaluation, and how quickly your child can start therapy.
1. Quick Overview: Start to First Session
Here's the condensed version if you're in a hurry. The full process from first contact to your child's first therapy session takes between 1-14 days, depending entirely on how fast your insurance company authorizes services.
| Step | What Happens | Typical Timeframe |
|---|---|---|
| 1. Contact | Intake team reaches out, answers questions, sends packet | Same day |
| 2. Documents | You submit diagnosis, insurance card, completed forms | 1-3 days (your pace) |
| 3. Authorization | We submit to insurance for assessment approval | 1-14 days |
| 4. Meet BCBA | Introduction to your Board Certified Behavior Analyst | Within 24 hours of approval |
| 5. Assessment | BCBA conducts initial evaluation, observes your child | 2-4 hours over 1-2 visits |
| 6. Treatment Plan | BCBA creates plan, reviews with you, submits to insurance | 3-5 days |
| 7. Start Services | Direct therapy begins in home or school | Immediately after insurance approves plan |
The bottleneck is always insurance authorization. Some insurers respond in 24 hours, others take two weeks. We submit requests the same day we receive your documents.
2. What You Need Before Contacting Us
You don't need much to get started. The two required items are a formal autism diagnosis and proof of insurance.
Required Documents
- Autism Spectrum Disorder diagnosis: From a licensed psychologist, developmental pediatrician, or psychiatrist. Must include the diagnostic code (typically F84.0 or similar).
- Insurance card: Front and back, clearly legible. We need member ID, group number, and contact information for behavioral health benefits.
- Consent forms: We provide these in the intake packet. Standard authorization for assessment and treatment.
Helpful But Not Required
- Previous therapy reports (speech, occupational therapy, early intervention)
- School IEP or 504 plan if your child has one
- List of current medications and prescribing doctors
- Any recent psychological or developmental evaluations
If your child doesn't have an autism diagnosis yet, we can guide you toward assessment options. See our pages on ADOS-2 assessments, M-CHAT screening, and diagnostic services.
3. Insurance Coverage: Medicaid vs Private Insurance
Insurance covers the majority of ABA therapy costs for most families. The amount you pay depends on whether you have Medicaid or private insurance with autism benefits.
Medicaid families pay $0 out of pocket. If Medicaid is your primary or secondary insurance, ABA therapy is covered at 100% with no deductible, no copay, no coinsurance. This applies in all five states we serve.
Medicaid Coverage (100% Covered)
Medicaid plans are required by federal law to cover medically necessary behavioral health services for children under 21. ABA therapy for autism qualifies as medically necessary in Colorado, New Hampshire, New Jersey, Kansas, and Ohio.
You pay nothing. No session fees, no assessment fees, no authorization fees. Achieving Stars Therapy bills Medicaid directly and handles all paperwork.
Private Insurance Coverage (Varies by Plan)
Private insurance coverage depends on your specific plan. All five states we operate in have autism insurance mandates requiring coverage for ABA therapy, but the details vary.
| What You Might Pay | Details |
|---|---|
| Deductible | If your plan has a deductible, you pay out of pocket until you meet it, then insurance covers the rest |
| Copay | Fixed amount per session (e.g., $20-$50 per visit) |
| Coinsurance | Percentage of the session cost (e.g., you pay 20%, insurance pays 80%) |
| Out-of-pocket maximum | Once you hit this annual limit, insurance covers 100% for the rest of the year |
Our intake team verifies your benefits before services start. We'll tell you exactly what your plan covers and what you'll pay per session. No surprises.
Common Insurers We Work With
- UnitedHealthcare
- Aetna
- Cigna
- Blue Cross Blue Shield (all state plans)
- Anthem
- Kaiser Permanente
- Tricare
- State Medicaid programs (all five states)
If your insurer isn't listed, contact us. We're constantly adding new contracts and can verify whether we're in-network with your plan.
4. Step-by-Step: The Complete Onboarding Process
Here's what happens from the moment you contact us to when your child starts therapy sessions.
Step 1: Initial Contact and Intake
Our intake team calls or emails you within 24 hours of your inquiry. They'll ask basic questions about your child's age, diagnosis, and what behaviors or skills you want to address. This conversation typically takes 15-20 minutes.
You'll receive the intake packet via email immediately after this call. The packet includes consent forms, a brief questionnaire about your child's curr