Do you have a state regulated “fully funded” health plan or a self-insured “ERISA” plan? This is an important distinction because the state mandated insurance for Florida and many other states do not cover self-insured ERISA plans. Typically companies that are very large have self-insured plans that they allow the health companies to manage. It is still possible for your self-insured plan to cover ABA for autism. It is all in the fine print of your “Evidence of Coverage or “Plan Description” manuals.
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This may be an important distinction for you as your out-of-pocket costs can be, but is not always, affected by this distinction. Since there are not many innetwork providers of ABA services, insurance companies have to write single case agreements and as a result, the care is considered to be in-network in most cases.
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