Yes, we work extensively with Anthem to provide coverage for Applied Behavior Analysis (ABA) therapy for families in Virginia. Anthem is one of the most common carriers we partner with, and their coverage approach is supported by Virginia’s legislative framework, which bases approvals on medical necessity rather than age limits or dollar caps.
To ensure your child can Succeed with ABA, we provide comprehensive Insurance management and authorization services, including:
- Eligibility Verification: We perform a free check of your specific Anthem plan to confirm your behavioral health benefits, deductibles, and copays.
- Prior Authorization: Our team handles the entire prior authorization for ABA therapy process. We submit the required clinical documentation and treatment plans developed by our BCBAs to justify medical necessity to Anthem.
- Billing and Coding: We manage all billing using standardized ABA therapy CPT codes (such as 97151, 97153, and 97155) to ensure accurate claim processing.
It is important to note that if you have a self-insured (ERISA) plan through a large employer, coverage may vary as these plans are sometimes exempt from state mandates. We will work directly with your insurer to clarify these nuances for you. You’re not on your own in this process; we handle the administrative heavy lifting so you can focus on your child’s milestones.
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