Skip to the content
Find a provider

Aetna ABA therapy coverage

Yes, for autism, when the child meets Aetna's medical necessity rules. Aetna treats ABA for conditions other than autism as unproven, and your own plan terms still decide what is covered.

Read the Aetna policy
A parent on the phone to Aetna, with the insurance card and a notepad

What the Aetna policy says

Policy
Aetna Clinical Policy Bulletin 0648: Autism Spectrum Disorders, used with the Aetna Applied Behavior Analysis Medical Necessity Guide Source: Aetna.
Coverage
Yes, for autism, when the child meets Aetna's medical necessity rules. Aetna treats ABA for conditions other than autism as unproven, and your own plan terms still decide what is covered. Source: Aetna [2].
Diagnosis
Your child needs a DSM-5 autism diagnosis from a qualified provider, such as a psychologist, psychiatrist, or doctor. A standard test from the past 12 months must also show a real problem with daily functioning. Source: Aetna.
Prior authorization
Yes. The ABA provider must ask Aetna for approval (precertification) before treatment, usually online through Availity. Missing medical records can delay or block the approval. Source: Aetna.
Progress reviews
Aetna checks your child's progress every six months. A child who is not making progress will be moved to other services. Source: Aetna.
Hours
Approved hours depend on how severe your child's needs are. As a guide, full-scope ABA for ages 0 to 7 is often 10 to 25 hours a week, and focused ABA is often 1 to 20 hours a week. Source: Aetna.
Who can provide it?
ABA must be given or billed by a licensed behavior analyst, a board-certified behavior analyst (BCBA), or a licensed psychologist who can practice ABA. Other staff must be supervised. Source: Aetna.

Parents or guardians must take part in treatment. Many Aetna plans do not pay for ABA given during class time, so check your plan's exclusions. Source: Aetna [2].

Before the first session, ask Aetna three things

  1. Is ABA a covered benefit on my plan, and is my plan fully insured or self-funded?
  2. Which ABA providers near me are in network?
  3. What will I pay per session after the deductible, and what is my out-of-pocket maximum?

The member number on your card is all they need. Then use the list for your city and ask each provider whether they're in network with your plan.

ABA therapy providers by city

Other plans: TRICARE, Blue Cross and Blue Shield (Excellus BCBS, New York), UnitedHealthcare (Optum Behavioral Health), Cigna, Medicaid by state.