Understanding NH Medicaid & Insurance Coverage for ABA Therapy: A Complete Guide

New Hampshire's Autism Insurance Law

New Hampshire has strong autism insurance laws. RSA 417-E:8 requires all health policies to cover autism diagnosis and treatment, including ABA.

Key points about NH coverage:

• Applies to all commercial health plans in NH
• Covers children from diagnosis to age 21
• Includes comprehensive ABA services
• Requires coverage for medically necessary treatment
• No discriminatory deductibles or copays

NH Medicaid (Medicaid Care Management) Coverage

NH Medicaid covers ABA therapy for eligible children. It uses these managed care organizations (MCOs):

NH Medicaid MCOs That Cover ABA Therapy:

• NH Healthy Families (Amerihealth Caritas)
• WellSense Health Plan
• Granite State Health Plan

Buzz ABA in Concord is in-network with all major NH Medicaid plans. This makes services accessible with little to no cost.

NH Medicaid ABA Coverage Details:

• Covers medically necessary ABA hours (often 20-40 hours/week)
• No annual or lifetime dollar caps
• Minimal or no copays
• Covers in-home and clinic-based therapy
• Includes parent training
• Covers assessments and evaluations

Private Insurance Coverage in New Hampshire

Major private insurers in NH cover ABA therapy. We work with these insurers in Concord:

• Anthem Blue Cross Blue Shield of NH
• Harvard Pilgrim Health Care
• Cigna
• Aetna
• United Healthcare
• Tufts Health Plan

What Private Insurance Typically Covers:

• Initial assessments and planning
• Direct ABA therapy by RBTs
• BCBA supervision
• Parent training
• Progress updates
• Center-based and in-home therapy

Understanding Your Insurance Benefits

Before starting ABA therapy, it's important to understand these key aspects of your insurance plan:

1. Prior Authorization Requirements

Most insurance plans require prior authorization before starting ABA therapy. This process typically involves:

• Submitting your child's autism diagnosis documentation
• BCBA assessment results and treatment recommendations
• Clinical justification for the recommended number of therapy hours
• Review and approval by the insurance company (typically takes 5-14 business days)

At Buzz ABA, our insurance specialists handle the entire prior authorization process for you, ensuring all necessary documentation is submitted correctly and promptly.

2. Annual Coverage Limits

While NH law prohibits discriminatory limits on autism coverage, some plans may have specific benefit structures:

• Many plans offer unlimited medically necessary ABA therapy
• Some plans have annual visit or dollar limits (though these must be comparable to limits on other medical services)
• Limits are typically based on medical necessity, not arbitrary caps

3. Out-of-Pocket Costs

Your out-of-pocket costs for ABA therapy in NH typically include:

• Deductible: The amount you pay before insurance coverage begins (may range from $0 to several thousand dollars annually)
• Copays: Fixed amounts per session (typically $0-$50 per session for NH Medicaid)
• Coinsurance: Percentage of costs you pay after meeting deductible (commonly 0-20%)
• Out-of-pocket maximum: The most you'll pay in a year before insurance covers 100%

How to Verify Your ABA Therapy Benefits

Follow these steps to understand your specific coverage:

Step 1: Call Your Insurance Company

Contact the customer service number on your insurance card and ask specifically about:

• Coverage for Applied Behavior Analysis (ABA) therapy for autism
• Whether prior authorization is required
• In-network ABA providers in the Concord/NH area
• Your deductible, copay, and coinsurance amounts
• Annual visit or dollar limits
• Whether in-home and clinic-based therapy are both covered

Step 2: Get It in Writing

Request written confirmation of your benefits. Ask for a "benefits summary" or "explanation of benefits" document that outlines your ABA coverage details. Save all reference numbers from your insurance calls.

Step 3: Contact Buzz ABA for Free Benefits Verification

We'll check your benefits for you: Call us at (603) 555-0123 or fill out our intake form. We'll contact your insurance company to verify your autism benefits, copays, and deductibles.

• Contact your insurance company on your behalf
• Verify your exact ABA therapy coverage
• Determine your out-of-pocket costs
• Explain your benefits in clear, simple terms
• Handle all prior authorization paperwork
• Provide you with a detailed coverage summary before you commit to services

Common Insurance Coverage Scenarios in NH

What If Insurance Denies Coverage?

If your insurance denies ABA therapy coverage, don't give up. You have rights and options:

1. Understand the Denial Reason

Common denial reasons include:

• Ask for the denial letter in writing (they must provide this).
• Review the specific reason for denial (often it's a missing document or coding error).
• Contact us immediately—our billing team can often resolve these issues directly with the insurer.
• You have the right to appeal any denial under NH law.

2. File an Appeal

You have the right to appeal insurance denials. At Buzz ABA, we assist families with appeals by:

• Providing detailed clinical documentation
• Writing letters of medical necessity from our BCBAs
• Submitting research supporting ABA effectiveness
• Coordinating with your child's physician for supporting documentation

3. Contact NH Insurance Department

If you believe your insurance is violating NH's autism coverage law, you can file a complaint with the NH Insurance Department at (603) 271-2261 or insurance.nh.gov.

Financial Assistance Options

If you're struggling with out-of-pocket costs for ABA therapy, consider these options:

• Sliding Scale Programs: Buzz ABA offers sliding-scale fees based on family income for families facing financial hardship
• NH Medicaid: If your family qualifies, NH Medicaid provides comprehensive coverage with minimal costs
• Payment Plans: We work with families to create manageable payment plans for deductibles and copays
• Healthcare Savings Accounts (HSA/FSA): You can use these pre-tax accounts for ABA therapy costs
• Area Agency: May provide respite funding and other financial supports for families