Managed Health Services Insurance Coverage for ABA Therapy

Applied behavior analysis (ABA) therapy is a widely recognized treatment for children with autism spectrum disorder (ASD). Families often need to understand their insurance coverage for this essential therapy. Managed Health Services (MHS), a provider offering various health plans, does cover ABA therapy under specific conditions. Here’s what you need to know.

Understanding Managed Health Services (MHS)

Managed Health Services (MHS) is a health insurance provider in Indiana that offers a range of health plans, including Medicaid services. MHS is dedicated to providing comprehensive health coverage to its members, with a strong focus on quality care and access to necessary medical services. MHS operates in several states, with extensive services in Indiana, among others.

Coverage for ABA Therapy 

Eligibility Requirements

To qualify for ABA therapy coverage under MHS, the following criteria must be met:

• Diagnosis: A formal diagnosis of ASD from a qualified healthcare professional, such as a psychologist or psychiatrist, is required.
• Treatment Plan: The diagnosis must be accompanied by a detailed treatment plan outlining the necessity of ABA therapy. This plan must be approved by MHS.

Coverage Limits

MHS covers ABA therapy, but there are specific limits to the coverage:

• Session Limits: There may be a cap on the number of therapy sessions or hours covered per week or month. For example, some plans might limit coverage to a specific number of hours annually.

Approval Process

Obtaining coverage for ABA therapy involves several steps:

1. Prior Authorization: Before starting ABA therapy, prior authorization from MHS is required. This involves submitting a comprehensive treatment plan, including diagnosis, treatment goals, and justification for the therapy’s medical necessity.
2. Continued Authorization: Ongoing therapy requires periodic reviews to maintain authorization. These reviews ensure the therapy is effective and track the child's progress.

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Tips for Maximizing Your Coverage

Navigating insurance coverage can be complex, but these tips can help you make the most of your MHS benefits:

Understand Your Policy

Familiarize yourself with the terms of your insurance policy, including deductibles, copayments, and coverage limits. Knowing these details will help you manage your financial responsibilities.

Stay In-Network

Using in-network providers can reduce out-of-pocket costs. Ensure your ABA therapy provider is contracted with MHS.

Keep Detailed Records

Maintain comprehensive documentation of your child’s diagnosis, treatment plans, and progress reports. This information is crucial for obtaining and maintaining coverage.

Utilize the Appeals Process 

If your coverage request is denied, use the appeals process provided by MHS. Gather additional supporting documentation and follow the instructions for submitting an appeal.

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Conclusion

Navigating the insurance landscape for ABA therapy can be complex, but understanding Managed Health Services (MHS) coverage options ensures your child receives the necessary support. Being informed about eligibility requirements, coverage limits, and the approval process helps you effectively manage your child's ABA therapy needs.

At Step Ahead ABA, we prioritize fostering a positive and supportive environment where your child can learn, grow, and reach their full potential. Reach out to our representative today.

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