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 ABA 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 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 ABA 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 ABA 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:
- Aetna
- Texas Children's
- Molina Healthcare
- Superior HealthPlan
- Blue Cross Blue Shield of Texas
- UnitedHealthcare
- Wellpoint
- Community Health Choice
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 ABA therapy cost in the U.S.?
The cost of ABA 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.
All private commercial health insurance companies and Medicaid programs in the U.S. cover ABA 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 ABA therapy hours your insurance covers
- The number of ABA 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 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 ABA therapy
At HEMYS, we believe every child deserves access to 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 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 therapy should never be delayed by finances.
ABA 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).
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 ABA 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 ABA 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