Does Carolina Complete Health Cover ABA Therapy?

Yes, Carolina Complete Health generally covers the expenses for ABA therapy, under specific conditions.

Navigating insurance coverage for essential therapies such as Applied Behavior Analysis (ABA) can be challenging for families dealing with Autism Spectrum Disorder (ASD). Carolina Complete Health, a prominent managed care organization in the healthcare sector, offers a range of services, including coverage for ABA therapy under certain conditions.

Carolina Complete Health at a Glance

Carolina Complete Health is a joint venture between the North Carolina Medical Society and Centene Corporation. As a managed care organization, it provides comprehensive healthcare services to Medicaid-eligible individuals, encompassing medical, dental, and behavioral health services​​.

ABA Therapy Coverage

Carolina Complete Health extends coverage for ABA therapy, a critical component in the treatment of ASD, for individuals under the age of 21. This coverage falls under their Behavioral Health benefit, reflecting a commitment to addressing the diverse needs of children with autism​​.

Accessing ABA Therapy through Carolina Complete Health

To leverage this coverage, members should follow these steps:

• Initial Consultation: If you believe ABA therapy might benefit your child, start by discussing your concerns with your child's primary care provider (PCP).
• Referral Process: Your PCP can refer your child to a behavioral health provider for evaluation to determine if ABA therapy is suitable.
• Developing a Treatment Plan: Once ABA therapy is recommended, the behavioral health provider will collaborate with you to formulate a treatment plan. This plan will detail the therapy goals, the frequency of sessions, the specific type of therapy, and qualifications of the therapist providing care​​.

Conclusion

Carolina Complete Health provides essential coverage for ABA therapy for young individuals with ASD, aligning with their broader healthcare services. By engaging with primary care providers and behavioral health professionals, members can effectively access and utilize this coverage to support their child's developmental needs​​.

FAQ

Q: Is ABA therapy covered for all Carolina Complete Health members?

A: Carolina Complete Health covers ABA therapy for individuals with ASD who are under the age of 21, as part of their Behavioral Health benefit​​.

Q: What is the process to get ABA therapy approved through Carolina Complete Health?

A: To get ABA therapy approved, start by consulting your child's primary care provider (PCP). If your child is recommended for ABA therapy, a behavioral health provider will develop a treatment plan outlining the therapy's goals and details​​.

Q: Does the coverage for ABA therapy vary by age with Carolina Complete Health?

A: Yes, Carolina Complete Health's coverage for ABA therapy is specifically for individuals with ASD who are under the age of 21​​.

Q: Are there specific qualifications for therapists providing ABA therapy under Carolina Complete Health?

A: Yes, the treatment plan for ABA therapy will specify the type of therapy and the qualifications of the therapist providing it​​.