Cigna typically provides coverage for Applied Behavior Analysis (ABA) therapy in Missouri, generally categorizing it under outpatient or behavioral health benefits. However, because every Cigna plan is different, specific coverage limits are determined by your individual policy.

Key factors that influence coverage limits and costs include:

• Policy Type: Coverage details vary significantly between self-funded plans, fully insured plans, and specific state mandates.
• Session and Hour Caps: Annual limits, such as maximum session counts or hour caps, may apply depending on your specific policy.
• Medical Necessity: Coverage is tied to medical necessity criteria, which require a formal autism diagnosis and a recovery plan developed by a Board Certified Behavior Analyst (BCBA).
• Cost-Sharing: Families are usually required to meet a deductible before coinsurance or copays apply to ABA sessions.
• Prior Authorization: Cigna often requires prior authorization before therapy begins. Heart Core ABA assists families by verifying these benefits, gathering documentation, and submitting authorization requests to Cigna.

To determine your exact coverage limits, Heart Core ABA offers a free benefits verification service that provides a clear breakdown of your plan’s specific inclusions and potential out-of-pocket costs.