Does Missouri Law Require Private Insurance to Cover Aba Therapy?
Yes, Missouri law generally requires private insurance to cover ABA therapy for children diagnosed with autism spectrum disorder, provided the plan is a fully insured group or individual health plan. These plans are governed by Missouri state insurance regulations, which mandate coverage for the diagnosis and treatment of autism, including Applied Behavior Analysis.
However, it is important to note the following distinctions:
- Plan Type Matters: The mandate applies to state-regulated, fully insured plans. If you have a self-insured or ERISA employer plan, federal law governs the policy, and these plans are not legally bound by Missouri state mandates to cover ABA therapy.
- Coverage Limits: While the mandate requires meaningful coverage, plans may still impose rules regarding preauthorization, medical necessity, and visit-hour limits. Additionally, for compliant plans, there is an annual benefit cap of $40,000 for children through age 18.
- Verification: Because every plan is unique, it is essential to verify your specific coverage. Providers like Heart Core ABA offer complimentary benefits verification to help families clarify exactly what their specific plan offers and whether any out-of-pocket costs apply.
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