How do I Get Aba Therapy Approved by Cigna?

To get ABA therapy approved by Cigna, you must navigate a specific process that involves verifying coverage, obtaining medical authorization, and demonstrating clinical need. Heart Core ABA simplifies this by handling the following steps for you:

1. Insurance Verification: An initial check of your specific Cigna plan is required to identify deductibles, copays, and any session limits. This can be completed within 1–2 days to provide a clear breakdown of out-of-pocket costs.
2. Meeting Medical Necessity Criteria: Cigna requires proof that the therapy is essential for your child’s development. This documentation must typically include:

• A formal diagnosis of autism spectrum disorder (ASD).
• Evidence of specific skill-building needs.
• A treatment plan developed by a Board Certified Behavior Analyst (BCBA) that outlines medically necessary goals.

1. Prior Authorization: Before therapy begins, Cigna usually requires a formal prior authorization request. Heart Core ABA manages this by gathering clinical documentation, submitting the request, and following up with Cigna until a determination is made.
2. BCBA Assessment: A BCBA will conduct an in-home assessment to observe your child’s strengths and challenges, which forms the basis of the documentation sent to Cigna for approval.

Once authorization is received, sessions with a Registered Behavior Technician (RBT) can begin under the oversight of your dedicated BCBA.