Arizona's ABA Insurance Mandate
Arizona was among the early states to pass autism insurance reform legislation. Under Arizona law, most fully-insured commercial health plans are required to provide coverage for the diagnosis and treatment of autism spectrum disorder, including ABA therapy. This mandate removes lifetime dollar limits on ABA coverage and requires coverage to be provided on the same basis as other medical treatments.
However, the mandate applies only to plans regulated by the state of Arizona. Self-funded employer plans — which cover a large portion of working Arizonans — are regulated under federal ERISA law and are not subject to the state mandate. If your coverage is through an employer, it is essential to verify whether your plan is fully-insured (state-regulated) or self-funded (federally regulated).
Key Insurance Terms to Know
Deductible
The amount you pay out-of-pocket before your insurance begins covering costs. ABA therapy expenses count toward your deductible.
Copay / Coinsurance
Your share of costs after the deductible is met. A copay is a fixed dollar amount; coinsurance is a percentage of the service cost.
Out-of-Pocket Maximum
The most you will pay in a plan year before insurance covers 100% of covered services. ABA therapy counts toward this limit.
Prior Authorization
Advance approval from your insurance company required before ABA services begin. Your BCBA submits clinical documentation to obtain authorization.
In-Network vs. Out-of-Network
In-network providers have contracted rates with your insurer, resulting in lower costs. Out-of-network services may be covered at a lower rate or not at all.
Medically Necessary
Insurance companies require that ABA therapy be deemed medically necessary based on clinical documentation. Your BCBA's assessment and treatment plan support this determination.
Questions to Ask Your Insurance Provider
Before starting ABA therapy, call the member services number on your insurance card and ask:
Does my plan cover ABA therapy? Is it covered under behavioral health or medical benefits?
Is a diagnosis of autism spectrum disorder required, or are other diagnoses covered?
Is prior authorization required before services begin?
What is my deductible, copay/coinsurance, and out-of-pocket maximum for behavioral health services?
Is Copper Valley Behavioral Solutions in-network with my plan?
Are there any limits on the number of ABA therapy hours covered per year?
Is my plan fully-insured (state-regulated) or self-funded (ERISA)?
The Authorization Process: What to Expect
Diagnosis Confirmation
Your insurance company will require documentation of the qualifying diagnosis from a licensed provider before authorizing ABA therapy.
Initial Assessment
Your BCBA conducts a comprehensive assessment and develops an individualized treatment plan with specific goals and recommended service hours.
Prior Authorization Submission
Copper Valley submits the clinical documentation package to your insurance company, including the assessment results and proposed treatment plan.
Insurance Review
The insurance company's clinical team reviews the documentation, typically within 5–15 business days. They may approve, partially approve, or deny the request.
Services Begin
Once authorization is received, services can begin. Authorizations are typically valid for 6 months and must be renewed with updated progress data.