Insurance terms for ABA, explained (without the jargon)

The terms that usually matter most

• Deductible: what you pay before insurance starts covering services.
• Copay/coinsurance: what you pay per visit (copay) or percentage (coinsurance).
• Out-of-pocket max: the most you’ll pay in a year for covered services.
• In-network vs out-of-network: whether your provider has a contract with your plan.
• Authorization: approval needed before services/hours are covered.
• Medical necessity: the reason the plan approves coverage.

What to ask your insurance company

• Is ABA covered under my plan for my child’s diagnosis?
• Do I need prior authorization? How often is it renewed?
• What is my deductible, coinsurance, and out-of-pocket max?
• Is there a cap/limit on hours per year?

A realistic reminder

Insurance rules can be confusing and inconsistent. A good provider should help you understand what’s needed and what to expect, even if they can’t control your plan’s decisions.