Insurance and Autism

Understanding the basics of health insurance coverage of autism treatment in New Jersey.

Families of individuals with autism, and the professionals who support them, often use health insurance to fund treatment. These articles are designed to help readers understand the basics of health insurance coverage of autism treatment, teach how to recognize the different types of health coverage, learn the laws that affect coverage, and know what to do when encountering issues like claim denials.

Getting Coverage

Before an insurance carrier or employer will fund an individual’s treatment, that individual must be covered by an insurance plan or health plan. These articles explore some of the most common ways to get covered.

2023 | Insurance

Self-Funded Plans and ABA

Learn about benefits, minimum coverage requirements, and legal protections for self-funded plans.

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2023 | Insurance

Fully Insured Plans and ABA

Learn about benefits, minimum coverage requirements, and legal protections for New Jersey fully insured plans.

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2023 | Insurance

Medicaid and How To Enroll

This article will help you understand who is eligible for New Jersey Medicaid/NJ FamilyCare and how to apply.

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2023 | Insurance

Child-Only Health Insurance Plans

Families who have no coverage for ABA therapy under their employer-sponsored insurance plan can still purchase a child-only plan to ensure their child gets the therapy they need.

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2022 | Insurance

2023 Individual Insurance Open Enrollment

The enrollment period for individual insurance plans is open from November 1 to January 31.

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2021 | Insurance | Medicaid

Medicaid: Starting Treatment

Medicaid now covers ABA for autism! Learn how to access this benefit.

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SPECIAL CASES & RESOLVING PROBLEMS

Some families struggle to get the health coverage they need for a loved one with autism. The articles below deal with some special routes, processes, and plans that families can use to get the right coverage. Additional articles focus on some of the most common issues that arise when families and providers seek insurance coverage for autism treatment.

2023 | Insurance

Child-Only Health Insurance Plans

Families who have no coverage for ABA therapy under their employer-sponsored insurance plan can still purchase a child-only plan to ensure their child gets the therapy they need.

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2017 | Insurance

In-Network Exceptions

In some cases, a member may want to consider requesting an in-network exception.

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2017 | Insurance

Prompt Pay Law: Obtaining Timely Payments

Providers and parents of children with autism may face situations in which there is a delay in the payment of claims.

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2022 | Medicaid

Treatment When You Need It

Timely coverage of ABA by Medicaid is essential. Learn more about how you can ensure services are provided in a “reasonably prompt” timeframe.

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MEDICAID

Many families get their health coverage through Medicaid. Learn who is eligible, how to apply, and how to deal with obstacles when they arise.

2018 | Medicaid

Medicaid for Adults

Medicaid is required in order to receive DDD Services. The most frequent path to Medicaid is Social Security.

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2023 | Insurance

Medicaid and How To Enroll

This article will help you understand who is eligible for New Jersey Medicaid/NJ FamilyCare and how to apply.

Read More
2021 | Insurance | Medicaid

Medicaid: Starting Treatment

Medicaid now covers ABA for autism! Learn how to access this benefit.

Read More
2019 | Medicaid

Understanding the EPSDT Medicaid Benefit

EPSDT was created to ensure that potential health and developmental problems can be found early and addressed thoroughly.

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2022 | Medicaid

Treatment When You Need It

Timely coverage of ABA by Medicaid is essential. Learn more about how you can ensure services are provided in a “reasonably prompt” timeframe.

Read More

FOR PROVIDERS

Clients may call on their service providers to advocate with their insurance company or assist them as in the claims appeal process. Learning more about health insurance can help providers support their families and expand access to services across the state.

2017 | Insurance

In-Network Exceptions

In some cases, a member may want to consider requesting an in-network exception.

Read More
2017 | Insurance

Prompt Pay Law: Obtaining Timely Payments

Providers and parents of children with autism may face situations in which there is a delay in the payment of claims.

Read More
2019 | Medicaid

Understanding the EPSDT Medicaid Benefit

EPSDT was created to ensure that potential health and developmental problems can be found early and addressed thoroughly.

Read More
2021 | Medicaid

Becoming a Medicaid/NJ FamilyCare Provider

Information about how providers can enroll to offer this important benefit.

Read More
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