ABA Insurance Mandates in New Hampshire: Your Coverage Rights
In short: New Hampshire requires most state-regulated health plans to cover medically necessary applied behavior analysis (ABA) therapy for autism. This includes private insurance plans and the state's Medicaid program. You have the right to request coverage, and ABA Therapy Now can help you find a vetted BCBA-led provider at no cost.
Key takeaways
- New Hampshire mandates ABA coverage for autism under state-regulated health plans and Medicaid.
- Coverage typically includes assessment, treatment, and parent training, with annual limits often tied to age.
- You can verify your specific benefits by calling your insurance or using a free matching service like ABA Therapy Now.
- ABA Therapy Now is a free service that connects you with vetted, BCBA-led providers in New Hampshire.
What Are ABA Insurance Mandates in New Hampshire?
New Hampshire has taken important steps to ensure that families have access to applied behavior analysis (ABA) therapy for autism. The state's insurance mandates require most health plans regulated by the state to cover medically necessary ABA services. This means that if you have a private insurance plan through an employer or purchase a plan on the individual market, you likely have coverage for ABA therapy. The mandate applies to plans issued or renewed after January 1, 2012, and includes coverage for diagnosis, assessment, and treatment of autism spectrum disorder (ASD).
It's important to note that these mandates do not apply to all plans. Self-funded employer plans (often called ERISA plans) are regulated by federal law and may not be subject to state mandates. However, many large employers still choose to include ABA coverage. The best way to know for sure is to check your specific policy or use a free service like ABA Therapy Now to help you navigate your benefits.
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Who Is Covered Under New Hampshire's ABA Mandates?
Children and Adults
New Hampshire's mandate covers individuals diagnosed with autism spectrum disorder, typically from the time of diagnosis through age 21. Some plans may extend coverage to adults, but this varies. The mandate requires coverage for medically necessary ABA therapy, which includes behavioral health treatment, speech-language pathology, occupational therapy, and physical therapy when prescribed by a licensed physician or psychologist.
Medicaid Coverage
New Hampshire's Medicaid program, known as New Hampshire Medicaid, also covers ABA therapy for eligible children under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This means that if your child is enrolled in Medicaid, they can receive ABA services as long as they are deemed medically necessary. The state's managed care organizations, such as WellSense and AmeriHealth Caritas, must provide access to ABA providers.
What Does the Mandate Cover?
Under New Hampshire law, insurance plans must cover the following ABA-related services:
- Assessment and evaluation: A board-certified behavior analyst (BCBA) will conduct a functional behavior assessment to determine the child's needs.
- Behavioral treatment: One-on-one therapy sessions that focus on skill development and reducing challenging behaviors.
- Parent training: Training for parents and caregivers to implement strategies at home.
- Treatment plan development: A written plan that outlines goals, interventions, and progress monitoring.
Coverage limits vary by plan. Some plans may have annual dollar caps or session limits. For example, a plan might cover up to $36,000 per year for ABA therapy, or up to 40 hours per week. It's crucial to review your specific policy or contact your insurance company to understand your exact benefits.
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How to Verify Your ABA Coverage in New Hampshire
Step 1: Check Your Insurance Policy
Start by reading your insurance policy documents. Look for terms like "applied behavior analysis," "autism treatment," or "behavioral health." If you have trouble finding this information, call the customer service number on your insurance card and ask specifically about ABA coverage for autism.
Step 2: Ask the Right Questions
When you call your insurance company, ask these key questions:
- Does my plan cover ABA therapy for autism?
- Are there any annual or lifetime limits on coverage?
- Do I need a referral or prior authorization?
- What is my deductible, copay, or coinsurance for ABA services?
- Are there in-network providers I must use?
Step 3: Use a Free Matching Service
ABA Therapy Now is a free service that helps families in New Hampshire find vetted, BCBA-led providers. We can also help you verify your insurance benefits and understand your coverage rights. Simply fill out our online form, and we'll match you with a provider who accepts your insurance and meets your needs.
Common Mistakes to Avoid When Using Your ABA Coverage
- Not verifying coverage before starting therapy: Always confirm your benefits before beginning services to avoid unexpected costs.
- Assuming all plans are the same: Coverage varies widely between insurance companies and even between plans from the same company.
- Ignoring prior authorization requirements: Many plans require prior authorization before ABA therapy can begin. Failure to obtain it can result in denied claims.
- Not appealing denied claims: If your insurance denies coverage, you have the right to appeal. Many denials are overturned on appeal.
- Choosing a provider without checking network status: Using an out-of-network provider can lead to higher costs or no coverage at all.
What to Do If Your Insurance Denies Coverage
If your insurance company denies coverage for ABA therapy, don't give up. You have the right to appeal the decision. Start by requesting a written explanation of the denial. Then, gather supporting documentation, such as a diagnosis from a qualified professional, a letter of medical necessity from your doctor, and a treatment plan from a BCBA. Submit a formal appeal to your insurance company, and if that fails, you can request an external review by the New Hampshire Insurance Department.
The New Hampshire Insurance Department can help you understand your rights and file a complaint if necessary. You can contact them at (603) 271-2261 or visit their website for more information.
How ABA Therapy Now Can Help
Navigating insurance mandates and finding the right provider can be overwhelming. That's where ABA Therapy Now comes in. We are a free matching service that connects families in New Hampshire with vetted, BCBA-led ABA providers. We work with a network of providers who accept a wide range of insurance plans, including Medicaid. Our team can help you verify your benefits, understand your coverage rights, and find a provider that fits your family's needs.
Getting started is easy. Visit our website, fill out a short form, and we'll match you with a provider in your area. There's no cost to you, and we never share your information without your permission. Let us help you access the ABA therapy your child deserves.
Frequently Asked Questions About ABA Insurance Mandates in New Hampshire
Here are answers to some common questions families have about ABA coverage in New Hampshire.