Does Insurance Cover ABA Therapy in Texas? What Parents Need to Know

One of the most frequently searched questions among Texas parents of children with autism is 'Does insurance cover ABA therapy in Texas?' The answer is: in most cases, yes, and it has been the law since 2007. This guide explains the Texas insurance mandate for ABA therapy, which insurance plans are covered, and how to navigate the process of getting your benefits verified.

The Texas Autism Insurance Law

Texas Insurance Code Chapter 1355, commonly known as the Texas Autism Insurance Reform Act, requires most health insurance plans issued or renewed in Texas to cover ABA therapy as a medically necessary treatment for autism spectrum disorder (ASD). The law was first enacted in 2007 and has been strengthened through subsequent amendments.

Under Chapter 1355, covered insurance plans must provide benefits for: ABA therapy (Applied Behavior Analysis), speech therapy, occupational therapy, and physical therapy, all when prescribed for ASD. The law does not cap the number of treatment hours and does not set an age limit for coverage.

Which Insurance Plans Are Covered by the Texas Mandate?

The Texas mandate applies to: individual and family health insurance plans issued in Texas, fully-insured employer group plans subject to Texas state law, and small-group plans (generally employers with 2-50 employees).

The mandate does not apply to self-funded (ERISA) plans, which are typically offered by large employers who self-insure. These plans are regulated by federal ERISA law rather than state law. However, many large employer self-funded plans voluntarily cover ABA therapy regardless of the state mandate.

Medicaid/CHIP in Texas covers ABA therapy for eligible children through the Comprehensive Care Program (CCP) and the STAR Kids Medicaid waiver program.

Major Insurance Carriers That Cover ABA in Texas

Aetna: Covers ABA therapy in Texas. In-network with Belong ABA. Prior authorization typically required.
Blue Cross Blue Shield of Texas: Covers ABA therapy. In-network with Belong ABA. Among the most commonly used plans in DFW.
Cigna: Covers ABA therapy. In-network with Belong ABA. Good coverage for DFW-area employer groups.
Tricare: Covers ABA therapy for military families and dependents with an autism diagnosis. Belong ABA accepts Tricare.
UnitedHealthcare: Covers ABA therapy in Texas. In-network with Belong ABA. Largest commercial carrier in the U.S.

How to Verify Your ABA Therapy Benefits

To verify your ABA therapy benefits, you can: (1) call the member services number on the back of your insurance card and ask specifically about ABA therapy benefits for autism under your plan; (2) contact Belong ABA and let our intake team do the verification for you at no cost; or (3) request a copy of your Summary of Benefits and Coverage (SBC) from your employer or insurance carrier.

Our intake team asks for your insurance card, the member ID, and your child's date of birth. We then contact your insurance company directly, confirm the benefits, and provide you with a clear explanation of your coverage and cost-sharing before services begin.

What If My Insurance Claim Is Denied?

Insurance denials for ABA therapy do happen, even when coverage is mandated by Texas law. Common reasons for denial include: lack of a formal autism diagnosis on file, insufficient documentation of medical necessity, or issues with the prior authorization submission. If your ABA therapy claim is denied, you have the right to appeal. Belong ABA's billing team assists families with the appeals process, and the Texas Department of Insurance can be contacted if you believe your insurer is not complying with the state mandate.