MDwise Insurance Coverage for ABA Therapy

Helping your child with autism spectrum disorder (ASD) thrive can feel like a constant quest. Applied behavior analysis (ABA) therapy can be a powerful tool in their journey, but navigating insurance coverage can add another layer of complexity.

MDwise, a healthcare provider offering plans specifically for Indiana residents, recognizes the importance of ABA therapy for children with ASD. They aim to simplify the process by offering coverage under certain conditions, potentially easing some of the burden on families. This guide will help you understand how MDwise can be a partner in your child's development.

Understanding MDwise

MDwise is a health insurance provider offering a range of plans to individuals and families in Indiana. MDwise is known for its Medicaid plans, including Hoosier Healthwise, the Healthy Indiana Plan (HIP), and Hoosier Care Connect. These plans aim to provide comprehensive healthcare coverage, including ABA therapy for children with autism.

Coverage for ABA Therapy

MDwise does cover ABA therapy, but the specifics depend on the plan you have. Here’s a breakdown:

Hoosier Healthwise:

• Eligibility: Children under 21 with a formal diagnosis of ASD.
• Coverage Limits: Up to 30 hours of therapy per week, with a maximum benefit of $120,000 per year​​.

Healthy Indiana Plan (HIP):

• Eligibility: Individuals with ASD.
• Coverage Limits: Limited to 60 hours of ABA therapy per year​​.

MDwise Marketplace Plans:

• Coverage Specifics: Vary depending on the selected plan. It’s essential to review your plan documents to understand the exact coverage details​​.

‍

Approval Process

Obtaining coverage for ABA therapy involves several steps:

1. Prior Authorization

Before starting ABA therapy, you need prior authorization from MDwise. This involves submitting a detailed 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, ensuring the therapy's effectiveness and monitoring the child's progress​​.

‍

Tips for Maximizing Your Coverage

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

Understand Your Policy

Familiarize yourself with 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 MDwise.

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 MDwise. Gather additional supporting documentation and follow the instructions for submitting an appeal​.

Conclusion

MDwise does provide coverage for ABA therapy, but the specifics depend on the plan you have. Understanding your coverage options, eligibility requirements, and the approval process is essential for maximizing your benefits. 

Don't let navigating insurance become a roadblock. With MDwise coverage and Step Ahead ABA's expertise, you can empower your child's journey towards a brighter future. Contact us to schedule a consultation and unlock your child's full potential.