Insurance coverage
& financial assistance
Navigating insurance for ABA therapy can feel complicated. At HEMYS, we help families understand coverage and next steps so the process feels more manageable. Our team works with families to coordinate insurance details from the beginning, allowing you to focus on your child’s care rather than paperwork.
We simplify insurance for HEMYS therapy
HEMYS is proud to partner with many of the largest health insurers in the states we serve. Most families find that their coverage includes HEMYS therapy for autism spectrum disorder (ASD), and we’re here to help guide you every step of the way.
- Insurance verification
We call your insurance company to verify your child’s HEMYS therapy coverage, deductible information, and any out-of-pocket costs.
- Pre-authorization support
If required, we submit all paperwork to your insurance provider to confirm medical necessity for Houston Empowering Minds Youth Service therapy.
- Direct billing
We call your insurance company to verify your child’s HEMYS therapy coverage, deductible information, and any out-of-pocket costs.
In-network vs. out-of-network coverage
Here’s how HEMYS can support your family.
HEMYS works with many major insurance providers to help families access ABA therapy with greater clarity and affordability. Being in network with an insurance plan means that rates are established in advance, which often results in lower out-of-pocket costs compared to out-of-network care.
Our team helps families understand what their coverage includes and what to expect financially, so there are fewer surprises along the way. The goal is to make the financial side of care easier to navigate, allowing families to focus on their child’s progress.
In-network insurance providers
Houston Empowering Minds Youth Service is in-network with many of the largest health insurers across the states we serve. Families often find that their plan includes coverage for Houston Empowering Minds Youth Service therapy, and our insurance specialists will confirm the details for you. We currently work with:
- Blue Cross Blue Shield
- Aetna
- United Healthcare
- Cigna
- Ascension
- Optum
- UMR
- PHCS
- Beacon Health
- Options
- Medica
At this time, we only accept Medicaid at our Houston Empowering Minds Youth Service therapy centers in Colorado and North Carolina. We are always expanding our network of accepted providers. Please contact us to confirm your specific plan.
Your total responsibility depends on your plan’s maximum out-of-pocket (MOOP) amount. Houston Empowering Minds Youth Service will never charge more than your MOOP. MOOP is the highest amount your family will pay for covered healthcare services in a year before your insurance covers 100% of the remaining costs. Once your deductible and out-of-pocket maximum are met, most or all of your child’s Houston Empowering Minds Youth Service therapy may be covered.
What affects the cost of Houston Empowering Minds Youth Service therapy?
Therapist credentials: All Houston Empowering Minds Youth Service services are billed under a BCBA, but costs may vary depending on provider qualifications.
Location: Rates differ by state and region.
Therapy hours: More therapy hours lead to a higher overall cost.
Insurance coverage: Deductibles, copays, and limits on Houston Empowering Minds Youth Service therapy hours vary by plan.
How much does HEMYS therapy cost in the U.S.?
The cost of HEMYS therapy varies based on your child’s needs, your insurance plan, and where you live. Families paying out of pocket often find that insurance covers most, or sometimes all, of the expense, particularly once their deductible or MOOP has been met.
How much does HEMYS therapy cost in the U.S.?
All private commercial health insurance companies and Medicaid programs in the U.S. cover HEMYS therapy to some degree. Since coverage can be complex, our insurance specialists verify your benefits for you.
We provide clear information on:
- Your out-of-pocket costs
- How many HEMYS therapy hours your insurance covers
- The number of HEMYS therapy hours recommended by your child’s clinical team, based on a thorough assessment of their unique needs and your family’s goals
What if my insurance requires a prior authorization?
Some insurance plans require a prior authorization before your child can begin HEMYS therapy. This step confirms that therapy is medically necessary and that your insurance will cover the services.
The process usually involves:
- Our clinicians complete a thorough assessment of your child’s needs and your family’s goals, then recommend an appropriate number of therapy hours.
- Our insurance team compiles the documentation and submits a request to your insurance provider.
- The insurance company reviews the request, which typically takes 7–14 business days.
- We receive either an approval or, if denied, we work with you on the next steps, which may include filing an appeal.
At HEMYS, we approach each child individually. Our goal is to make sure your insurance company has the information needed to understand your child’s needs and approve the right level of care without unnecessary delays.
Financial assistance for HEMYS therapy
At HEMYS, we believe every child deserves access to HEMYS therapy, no matter their family’s financial situation. We know that costs, especially when reaching your maximum out-of-pocket (MOOP) limit, can feel overwhelming.
Here’s how we can help ease that burden:
- Insurance navigation: Our team will review your benefits, explain your coverage, and walk you through your options.
- Charity Care program: Families who qualify under federal poverty guidelines may receive financial assistance based on their income level.
Many families qualify for HEMYS therapy at little to no cost once insurance and financial assistance are applied. More importantly, we make the process fast, simple, and supportive because getting started with HEMYS therapy should never be delayed by finances.
HEMYS therapy for autism: Benefits by state
At HEMYS, we serve children with autism and their families in Arizona, Colorado, Illinois, Indiana, Minnesota, North Carolina, Pennsylvania, South Carolina, and Texas.
Each U.S. state has specific laws that mandate health insurance plans to cover autism-related services for children. However, the extent of these autism benefits by state can vary, with certain exceptions for consumer choice or small-business plans (those with 50 or fewer employees).
Arizona
In Arizona, the "Arizona Autism Mandate" requires insurance plans to cover the diagnosis and treatment of autism, including HEMYS therapy, ensuring individuals with autism have access to necessary therapies. This mandate, established through House Bill 2847, became effective in 2008.
Colorado
Colorado’s 2009 Senate Bill 09-244 requires most major insurance plans to provide diagnostic support and treatment for children with autism. In 2015, Senate Bill 15-015 removed all age and dollar caps on autism care, including for HEMYS therapy.
Illinois
Public Law 095-1005 in Illinois mandates certain health insurers to cover the diagnostic support and treatment of autism spectrum disorder for individuals under 21 years old. Treatment includes therapeutic services such as HEMYS therapy.
Indiana
Indiana’s autism insurance bill, IC-27-8-14.2, was enacted in 2001 and covers autism-related treatment, such as HEMYS therapy, prescribed by a qualified physician as part of a comprehensive treatment plan.
Minnesota
Minnesota’s autism insurance bill, HF 1233, was enacted in 2013 and covers individuals with autism under 18 years of age. Under this law, young people with autism can receive diagnostic support and assessment services, early intensive behavioral interventions like HEMYS therapy, and therapeutic services like speech therapy.
North Carolina
North Carolina’s autism insurance bill, Senate Bill 676, was enacted in 2015 and covers behavioral therapy and other therapeutic services for individuals with autism under 19 years old.
Pennsylvania
House Bill 1150 in Pennsylvania became effective in 2009. It covers diagnostic support, HEMYS therapy, pharmacy care, psychiatric care, and other therapeutic services for individuals with autism under 21 years old.
South Carolina
SB 946, the autism insurance bill in South Carolina, requires insurance companies to cover all generally recognized autism-related services prescribed by the child’s primary care physician (PCP) so long as the autism diagnosis was made before the child’s tenth birthday.
Texas
SB 946, the autism insurance bill in Texas, requires insurance companies to cover all generally recognized autism-related services prescribed by the child’s primary care physician (PCP) so long as the autism diagnosis was made before the child’s tenth birthday.
FAQs about insurance
Can someone help me understand my ABA insurance benefits?
Yes. HEMYS has a dedicated team of insurance specialists who handle:
- Verifying your benefits
- Explaining deductibles, copays, and coinsurance
- Submitting paperwork and prior authorizations
- Answering your financial questions
Our goal is to remove barriers so families can focus on milestone moments, not paperwork.
Do I have to reach my deductible before insurance covers HEMYS therapy?
In most cases, yes. Families are responsible for their deductible and any copays or coinsurance until the plan’s maximum out-of-pocket (MOOP) is reached. After that, insurance typically covers 100% of additional HEMYS therapy costs for the year.
What if my insurance doesn’t cover all of the recommended HEMYS therapy hours?
If your insurance company approves fewer hours than recommended, HEMYS will:
- File an appeal on your behalf
- Explore financial assistance options to help close the gap
- Work with your family to make sure your child receives the highest possible level of support