Health Insurance Coverage for Autism
The New Jersey health insurance companies listed below may cover ABA services at various levels. It is advisable to compare plans as well as providers’ acceptances of coverage when choosing the best available plan for your child.
Please contact our Intake Department to discuss your options.
Medical Versus Educational Model Comparison
|MEDICAL MODEL||EDUCATIONAL MODEL|
|WHO DECIDES?||A medical team determines the focus, frequency and duration of therapy. Insurance coverage may be a determining factor.||An educational team, including parents, students (if appropriate), educators, administrators, and school-based therapists determines the student’s educational needs and what support is required by related services.|
|WHAT?||Therapy addresses medical conditions; works to get full potential realized.||Therapy focuses on adaptation and intervention to allow the student to participate and access their special education and school environment.|
|WHERE?||In the clinic, hospital, or home.||In the school environment|
|HOW?||Direct one-on-one treatment to accomplish set goals.||The student’s educational needs are met individually. Services can include direct one-on-one treatments, staff training, program development, integrated therapy, and inclusive therapy (with peers)|
|ELIGIBILITY||Medical need as determined by medical professionals.||Educational need as determined by an IEP team.|
|COST||Fee for service paid by family, insurance or governmental assistance.||No cost to student or family.|
|DOCUMENTATION||Dictated by insurance requirements and guidelines of the setting. Emphasis on medical terminology.||Related to IEP with accessible, readable language guided by the setting and best practice.|