NH Medicaid & Insurance for ABA

One of the most common questions we hear from New Hampshire families is, "Will my insurance cover ABA therapy?" The good news is that most insurance plans in NH, including Medicaid, do cover Applied Behavior Analysis therapy for children with autism. However, navigating insurance benefits can feel overwhelming. This comprehensive guide will help you understand your coverage and maximize your benefits.

Why We Care About Insurance Access

"Navigating insurance for our son's ABA therapy was one of the most frustrating parts of our journey after his autism diagnosis at age 8. The paperwork, phone calls, and authorization processes felt endless. That experience is exactly why we handle all insurance coordination for Buzz ABA families—so you can focus on your child, not on fighting with insurance companies."

New Hampshire's Autism Insurance Law

New Hampshire has strong autism insurance coverage requirements. Under NH RSA 417-E:8, all health insurance policies issued or renewed in New Hampshire must provide coverage for the diagnosis and treatment of autism spectrum disorders, including ABA therapy.

Key points about NH's autism insurance mandate:

Applies to all commercial health insurance plans in NH
Covers children from diagnosis through age 21
Includes comprehensive ABA therapy services
Requires coverage for medically necessary treatment
Cannot have separate deductibles or copays higher than other medical services

NH Medicaid (Medicaid Care Management) Coverage

New Hampshire Medicaid provides comprehensive coverage for ABA therapy for eligible children with autism. The state's Medicaid program includes several managed care organizations (MCOs):

NH Medicaid MCOs That Cover ABA Therapy:

NH Healthy Families (Amerihealth Caritas)
WellSense Health Plan
Granite State Health Plan

At Buzz ABA in Concord, we are in-network with all major NH Medicaid plans, making it easy for families to access services with little to no out-of-pocket costs.

NH Medicaid ABA Coverage Details:

Coverage for medically necessary ABA therapy hours (typically 20-40 hours per week based on clinical need)
No annual or lifetime dollar caps on coverage
Minimal or no copays for most families
Covers both in-home and clinic-based ABA therapy
Includes parent training and caregiver education
Covers initial assessments and ongoing evaluations

Private Insurance Coverage in New Hampshire

Most major private insurance companies in New Hampshire provide excellent ABA therapy coverage. Common insurers we work with in the Concord area include:

Anthem Blue Cross Blue Shield of NH
Harvard Pilgrim Health Care
Cigna
Aetna
United Healthcare
Tufts Health Plan

What Private Insurance Typically Covers:

Initial comprehensive ABA assessment and treatment planning
Direct ABA therapy services delivered by RBTs under BCBA supervision
BCBA supervision and program oversight
Parent training sessions
Periodic reassessments to track progress
Both center-based and in-home therapy settings

Understanding Your Insurance Benefits

Before starting ABA therapy, it's important to understand these key aspects of your insurance plan:

1. Prior Authorization Requirements

Most insurance plans require prior authorization before starting ABA therapy. This process typically involves:

Submitting your child's autism diagnosis documentation
BCBA assessment results and treatment recommendations
Clinical justification for the recommended number of therapy hours
Review and approval by the insurance company (typically takes 5-14 business days)

At Buzz ABA, our insurance specialists handle the entire prior authorization process for you, ensuring all necessary documentation is submitted correctly and promptly.

2. Annual Coverage Limits

While NH law prohibits discriminatory limits on autism coverage, some plans may have specific benefit structures:

Many plans offer unlimited medically necessary ABA therapy
Some plans have annual visit or dollar limits (though these must be comparable to limits on other medical services)
Limits are typically based on medical necessity, not arbitrary caps

3. Out-of-Pocket Costs

Your out-of-pocket costs for ABA therapy in NH typically include:

Deductible: The amount you pay before insurance coverage begins (may range from $0 to several thousand dollars annually)
Copays: Fixed amounts per session (typically $0-$50 per session for NH Medicaid)
Coinsurance: Percentage of costs you pay after meeting deductible (commonly 0-20%)
Out-of-pocket maximum: The most you'll pay in a year before insurance covers 100%

How to Verify Your ABA Therapy Benefits

Follow these steps to understand your specific coverage:

Step 1: Call Your Insurance Company

Contact the customer service number on your insurance card and ask specifically about:

Coverage for Applied Behavior Analysis (ABA) therapy for autism
Whether prior authorization is required
In-network ABA providers in the Concord/NH area
Your deductible, copay, and coinsurance amounts
Annual visit or dollar limits
Whether in-home and clinic-based therapy are both covered

Step 2: Get It in Writing

Request written confirmation of your benefits. Ask for a "benefits summary" or "explanation of benefits" document that outlines your ABA coverage details. Save all reference numbers from your insurance calls.

Step 3: Contact Buzz ABA for Free Benefits Verification

We'll check your benefits for you: Call us at (603) 555-0123 or fill out our intake form. We'll contact your insurance company to verify your autism benefits, copays, and deductibles.

Contact your insurance company on your behalf
Verify your exact ABA therapy coverage
Determine your out-of-pocket costs
Explain your benefits in clear, simple terms
Handle all prior authorization paperwork
Provide you with a detailed coverage summary before you commit to services

Common Insurance Coverage Scenarios in NH

Scenario 1: NH Medicaid Family

Scenario: Your child has NH Healthy Families (Medicaid).
Expected Coverage: Typically 100% covered with $0 copays for most families. We'll handle prior authorization, and your child can start services as soon as approval is received.

Scenario 2: Private Insurance, Deductible Not Met

Scenario: Your child has Anthem BCBS, and you haven't met your $2,000 annual deductible yet.
Expected Cost: You will likely need to pay for therapy sessions out-of-pocket until you reach the $2,000 deductible. After that, insurance typically covers 80-100% of costs. We offer payment plans to help manage deductible costs.

Scenario 3: Private Insurance, Deductible Met

Your child has Cigna, and you've already met your deductible from other medical expenses this year.

Expected Coverage: Most private plans will cover 80-100% of ABA therapy costs after deductible is met. You may have small copays per session or coinsurance percentages.

What If Insurance Denies Coverage?

If your insurance denies ABA therapy coverage, don't give up. You have rights and options:

1. Understand the Denial Reason

Common denial reasons include:

Ask for the denial letter in writing (they must provide this).
Review the specific reason for denial (often it's a missing document or coding error).
Contact us immediately—our billing team can often resolve these issues directly with the insurer.
You have the right to appeal any denial under NH law.

2. File an Appeal

You have the right to appeal insurance denials. At Buzz ABA, we assist families with appeals by:

Providing detailed clinical documentation
Writing letters of medical necessity from our BCBAs
Submitting research supporting ABA effectiveness
Coordinating with your child's physician for supporting documentation

3. Contact NH Insurance Department

If you believe your insurance is violating NH's autism coverage law, you can file a complaint with the NH Insurance Department at (603) 271-2261 or insurance.nh.gov.

Financial Assistance Options

If you're struggling with out-of-pocket costs for ABA therapy, consider these options:

Sliding Scale Programs: Buzz ABA offers sliding-scale fees based on family income for families facing financial hardship
NH Medicaid: If your family qualifies, NH Medicaid provides comprehensive coverage with minimal costs
Payment Plans: We work with families to create manageable payment plans for deductibles and copays
Healthcare Savings Accounts (HSA/FSA): You can use these pre-tax accounts for ABA therapy costs
Area Agency: May provide respite funding and other financial supports for families

Why Work with Buzz ABA for Insurance Navigation

At Buzz ABA in Concord, we understand that dealing with insurance can be stressful. That's why we:

Accept all major NH insurance plans, including NH Medicaid
Provide FREE insurance verification before you commit to services
Handle ALL insurance paperwork, authorizations, and billing
Work directly with insurance companies so you don't have to
Help with appeals if coverage is denied
Offer financial assistance options for families who need support
Provide transparent cost estimates before starting services

Our goal is to remove insurance barriers so your child can access the life-changing ABA therapy they need.

Get Free Insurance Verification

Start Your Child's Journey Today

Buzz ABA provides comprehensive, evidence-based ABA therapy in Concord, Manchester, Nashua, and surrounding NH communities. Our neurodiversity-affirming approach helps children thrive.

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