Cigna Insurance Coverage for ABA Therapy

Navigating the complexities of health insurance coverage can be challenging, especially when seeking essential treatments like applied behavior analysis (ABA) therapy for children with autism spectrum disorder (ASD). If you're wondering whether Cigna covers ABA therapy, this comprehensive guide will provide you with the information you need.

Understanding ABA Therapy

ABA therapy is a widely recognized treatment for individuals with ASD. It uses principles of learning and behavior to help children improve social skills, communication, and adaptive behaviors. Given its effectiveness, many insurance providers, including Cigna, offer coverage for ABA therapy.

Cigna's Coverage for ABA Therapy

Cigna does provide coverage for ABA therapy, but the specifics can vary based on your plan and location. Here’s what you need to know:

State Requirements

In certain states, such as New York, there are mandates that require insurance companies to cover ABA therapy as part of the treatment for autism. This means that if you live in one of these states, your Cigna plan is more likely to include coverage for ABA therapy​.

Plan Specifics 

The coverage details depend on the specific Cigna health plan you have. Some plans might cover ABA therapy fully, while others may have limitations on the number of sessions or the total cost covered. It's crucial to review your plan documents or contact Cigna directly to understand your coverage limits​.

Medical Necessity

Coverage for ABA therapy typically requires a diagnosis of ASD and a recommendation from a licensed healthcare provider. Cigna often requires that the therapy be medically necessary, which means it must be prescribed by a doctor or a licensed therapist and deemed essential for the child's development.

In-Network vs. Out-of-Network

Cigna covers ABA therapy provided by in-network therapists, which can help minimize out-of-pocket costs. If you choose an out-of-network provider, Cigna may still offer coverage, but you might have to pay a higher percentage of the costs​ 

Pre-Authorization

Some Cigna plans may require pre-authorization for ABA therapy. This means you need to get approval from Cigna before starting the therapy to ensure that the costs will be covered. This step helps verify that the therapy is necessary and that the provider meets Cigna's qualifications​​.

How to Verify Your Coverage

To ensure your child receives the necessary ABA therapy without unexpected costs, follow these steps:

  1. Review Your Plan

Check your Cigna health plan details for specific information about ABA therapy coverage. Look for sections on behavioral health or autism treatment.

  1. Contact Cigna

Reach out to Cigna’s customer service for personalized assistance. They can clarify your coverage, including any pre-authorization requirements and in-network provider options.

  1. Consult Your Healthcare Provider

Work with your child’s doctor or therapist to get the required documentation and recommendations for ABA therapy. They can also help with the pre-authorization process if needed.

Conclusion

Cigna's coverage for ABA therapy can be a valuable resource for families seeking treatment for children with ASD. Understanding the specifics of your plan and working closely with healthcare providers and Cigna representatives will help ensure that your child gets the necessary support. With the right information and resources, you can navigate the insurance process more effectively and focus on your child's progress.

For more information on ABA therapy and insurance coverage, visit Step Ahead ABA’s resource center or contact us directly.

Most major insurances accepted

Don’t see your network here?
Let us verify your coverage and help get you authorized.

Reach out
White Arrow pointing top right

We accept Medicaid & all major insurances
for ABA Therapy

Get the support you seek today.

Our team is eager to address your questions and concerns.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

ABA impact: Real life success stories

Get a glimpse at the impact of ABA on our client’s lives, with
these genuine success stories shared by our proud team.

*All names have been changed to ensure client confidentiality.

"All year, Sophia* has been working towards integrating into the gen-ed class at school and the hard work has paid off! Next week, after spring break, she will be fully integrating all day!
But that’s not all. Sophia’s school goes on regular trips to the swimming pool and we have been working hard on swimming independently in a community pool (as opposed to at water parks, where Sophie is more confident). Yesterday she swam in the pool independently for the first time while telling herself she could do it and earned a strawberry ice cream afterward to celebrate!"

RBT - Indiana

“I’ve been working with Mia* for a year and a half. Mia had a good start to many skills but her challenging behaviors were getting in the way of her ability to be successful in a daycare environment. She often became upset and refused to follow instructions, even for activities she enjoyed. She would spend a lot of her day having tantrums and resist doing things she was asked, which made it difficult for her to interact with other children or make progress academically. After eighteen months of hard work from her whole team at Step Ahead, she was able to decrease challenging behaviors to near zero levels, successfully transition into a Kindergarten setting and make friends without requiring prompting. Mia did so well that we were able to completely transition her out of our services and she is now an independently successful Kindergartener!”

Regional Director - Indiana

“Liam* has made so much progress in his communication! When I first started he was only using physical gestures to express his needs. He is now independently using 2+ word requests in every session! His parents have also reported that he is using verbal requests independently, outside of session as well. I am so proud of Liam and how much progress he has made!”

RBT - North Carolina

“I’ve been working on eating a wider variety of foods with my kiddo, Logan, tolerating new foods and being okay with alternatives if a preferred food is not available. In the past, his caregivers dealt with tantrums that were hours long and Logan would refuse to eat if a preferred food wasn't available. The other day, when Logan asked for fries, his caregiver did an AMAZING job confidently offering alternatives- "You can have salad or rice". Logan chose rice and ate all of what was served to him!
Recently, he’ll even prepare non-preferred food items that we’ve been working on, so when I arrive he can show them to me. He points to it and says "Eat! Good!" while giving me a thumbs up.”

Lead RBT - Nebraska

“We’ve been working with Ava* for 3 months now and at my parent meeting last week, Mom and Dad stated that they are so happy with our services and the progress Ava has made. When we first started, she had little functional communication skills and she now asks to be played with, requests to stop an activity, and asks for more time! Ava’s parents are so happy with her progress that they want her sibling to receive in-home therapy too.”

BCBA - Oklahoma

Put your child on the path to progress.