Is ABA therapy mandated to be covered in NY and NJ?

Yes. Both New York and New Jersey require insurance plans to cover ABA therapy for autism.

What does medically necessary mean?

ABA is considered medically necessary when a child has an ASD diagnosis and therapy is recommended by a qualified clinician.

How quickly can we start?

Most families begin within 1–3 weeks, depending on insurance processing time.

Does insurance cover home-based and center-based ABA?

Yes — most plans cover both settings.

Do co-pays or deductibles apply?

This depends on your specific plan. Yellow Bus ABA explains all costs upfront before therapy begins.

What is primary insurance?

Primary insurance is the insurance policy that a healthcare provider must bill first. If you have multiple insurance policies, you do not get to choose which one is primary. The primary insurance is determined based on specific rules, depending on your child’s insurance coverage.

What is a deductible?

A deductible is an annual amount that you have to pay toward medical expenses before coverage kicks in for all of your medical benefits. Depending on your insurance plan, some benefits may kick in before the deductible is met.

What is an out-of-pocket maximum?

An out-of-pocket maximum is the most you can be expected to pay toward your healthcare expenses in any given year before your insurance pays for everything else at 100%.

A copay is a set amount that you are expected to pay, at the time of service, for particular services until your out-of-pocket maximum has been reached.

Coinsurance is the same principle as a copay, only instead of a fixed dollar amount, you pay a percentage of the overall charge for the services.

What are in-network providers?

In-network providers are healthcare providers who have established contracts with your insurance company. These contracts outline the responsibilities of both the provider and the insurance company and pre-negotiate rates for services provided. Prior to being accepted as an in-network provider, the insurance company conducts a thorough vetting and credentialing process to ensure that the provider meets their standards.

What are out-of-network providers?

Out-of-network providers are healthcare providers who do not have established contracts with your insurance company. This means that services provided by out-of-network providers may not be covered by your insurance or may be covered at a lower rate than in-network providers.

How can Yellow Bus ABA help families navigate insurance coverage for ABA therapy?

At Yellow Bus ABA, we are committed to providing high-quality ABA therapy to children with autism and their families. While we work hard to maintain in-network status with as many insurance companies as possible, we understand that some families may need to access out-of-network providers. Our team is available to help you navigate the insurance process and understand your options for accessing the care your child needs.

Why might a provider not be in-network with an insurance company?

There are various reasons why a provider may not be included in an insurance company’s network, such as the insurance company not accepting new providers, the provider declining to accept certain terms in the contract, the provider opting to leave the network due to issues with processes, payments, or support, or the insurance provider deciding to terminate the contract with the provider.

What are the benefits of an out-of-network provider?

While in-network providers may be the most cost-effective option for healthcare services, there are instances where accessing an out-of-network provider may be necessary. Out-of-network providers may offer specialized services or have unique expertise that cannot be found within the in-network provider network. Additionally, out-of-network providers may be a better fit for a family’s individual needs, preferences, or schedule. It’s important to understand the costs associated with accessing an out-of-network provider, but in some cases, the benefits may outweigh the additional expenses. Ultimately, families should carefully consider their options and work with their insurance company and healthcare provider to make the best decision for their individual situation. It’s important to note that there may be instances where accessing an out-of-network provider may actually be cheaper than an in-network provider.

What are Single Case Agreements (SCA)?

A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network healthcare provider for a specific patient. SCAs are typically used when a patient’s needs cannot be met by an in-network provider or when there are no in-network providers available within a reasonable distance. The agreement outlines the terms and conditions of the care to be provided and the payment for services. The insurance company may agree to cover the costs of care from the out-of-network provider for the duration of the agreement. SCAs can be a helpful option for families who are struggling to find appropriate care within their insurance network, but it’s important to note that they are not always guaranteed and are subject to negotiation between the provider and the insurance company. Families should work closely with their healthcare provider and insurance company to explore all available options for care.

My insurance policy covers ABA, why won't you accept it?

It’s important to note that healthcare providers are unable to simply accept an insurance policy for coverage of ABA therapy. In order for a provider to be In-Network, there must be an agreement in place between the provider and the insurance company. It is not uncommon for certain providers to not be contracted by specific insurance companies, and the process of establishing an In-Network agreement can be lengthy, taking up to two years to complete. While a provider may be willing to attempt to go In-Network to work with you, they may not be able to do so immediately or at all. It is important to explore all available options and work with your healthcare provider and insurance company to find a solution that meets your individual needs.

No provider accepts my insurance, what should I do?

If a family finds themselves in a situation where no healthcare providers in their area accept their insurance, it can be a challenging and frustrating experience. In this scenario, it’s important to explore all available options and resources. Families should reach out to their insurance company to see if there are any exceptions or provisions that may allow them to receive coverage using a SCA (single case agreement). It may also be helpful to work with a case manager or advocacy group to explore additional options for coverage, such as applying for Medicaid or other government programs. Additionally, families should consider reaching out to ABA providers and advocacy groups to ask for recommendations and advice on how to navigate the situation. While it may require some extra effort and creativity, there are often options available for families to receive the care that they need.

Why choose Yellow Bus ABA?

Yellow Bus ABA is the clear choice for families seeking high-quality, cost-effective care for their loved ones. With a team of multi-specialty ABA experts and numerous centers across the Tri-state region, we are well-equipped to provide the highest level of care to our clients. We are committed to evidence-based practices and ongoing training and development for our staff, ensuring that we always provide the most effective and up-to-date treatments. Additionally, our commitment to cost-effectiveness means that we work closely with families and insurance companies to provide affordable care that meets their needs. Choosing Yellow Bus ABA means choosing a trusted partner who is dedicated to the well-being of our clients and their families.

ABA Therapy Insurance & Funding

Insurance & Funding for ABA Therapy

Accessing high-quality ABA therapy should be simple, stress-free, and affordable. At Yellow Bus ABA, we accept most major insurance plans, including commercial insurance and Medicaid (New York), to ensure families receive the support they need as quickly as possible. Our dedicated insurance team handles every step—verification, authorizations, billing, and ongoing renewals—so you can stay focused on what matters most: your child’s progress.

Does Insurance Cover ABA Therapy?

Under both federal and state laws, insurance providers are required to cover Applied Behavior Analysis (ABA) therapy for individuals diagnosed with Autism Spectrum Disorder (ASD).ABA therapy is considered a medically necessary treatment, and most plans include substantial coverage.

Coverage typically includes:

BCBA assessments
1:1 ABA therapy sessions
Parent/caregiver training
Treatment planning & supervision
Center-based ABA
In-home ABA therapy
Social skills support (when clinically appropriate)

Every insurance plan is different — which is why our team handles verification for you.

Insurance Plans We Accept

Yellow Bus ABA currently accepts (but is not limited to):

New York

Aetna
Cigna
Empire BlueCross BlueShield
UnitedHealthcare
Oxford
Fidelis (varies by region)
Beacon Health Options
MVP Health Care
Medicaid (New York)
Child Health Plus (NY)
And other commercial plans

Virginia

Aetna
Cigna
Anthem Blue Cross Blue Shield (BCBS)
Sentara Health Plans (formerly Optima Health)
Sentara Community Plan (Virginia Medicaid)
Virginia Medicaid (Cardinal Care)
And more

Because insurance networks vary by location, we recommend verifying your plan before starting services.

How Insurance Verification Works

At Yellow Bus ABA, insurance verification is quick and stress-free.

Step-by-step process

1.Submit basic information
Complete our online form or speak with our intake team.

2.We verify your benefits
Our insurance specialists contact your provider directly to confirm coverage.

3.We explain your benefits clearly
You’ll receive a simple, understandable breakdown of:

what’s covered
required documentation
out-of-pocket costs (if any)
authorization timelines

4.We obtain all authorizations
Our team handles prior authorizations and medical necessity documentation.

5.Your BCBA assessment is scheduled
Once approved, a BCBA meets with your child to begin the evaluation process.

6.Therapy begins
You’re matched with a therapist, and your personalized ABA plan starts.

Most families are approved and ready to begin therapy within weeks—not months.

Medicaid Coverage for ABA Therapy

New York Medicaid

Yellow Bus ABA is an approved provider for Medicaid (New York).

NY Medicaid typically covers:

ABA assessments
BCBA supervision
Ongoing therapy hours
Parent training

Coverage varies based on:

Age
Diagnosis
Benefit type (Managed Care vs. FFS)
Plan requirements

Our team will guide you through the documentation needed for Medicaid approval.

Virginia Medicaid

River City by Yellow Bus ABA is an approved provider for Medicaid (Virginia).

What You Need for Insurance Approval

To begin ABA therapy, insurance providers generally require:

1. A formal Autism Spectrum Disorder (ASD) diagnosis

2. Documentation from a qualified provider:

Developmental pediatrician
Neurologist
Psychologist

3. Recent evaluation (within 2–3 years, depending on plan)

4. Completed intake documents

If your child does not yet have a diagnosis, our team can guide you to local evaluators.

No Diagnosis Yet? We Can Help

Families often begin the journey before securing an official ASD diagnosis. Our team can help connect you with trusted diagnostic providers across:

New York City
Long Island
Westchester
Orange County
Dutchess County
Northern New Jersey

We walk you through the entire process so you can avoid delays in accessing care.

Our Commitment to Transparency

Insurance can be confusing. Yellow Bus ABA makes the process as simple and transparent as possible by providing:

Clear benefit explanation
Estimated therapy hours based on coverage
No surprise billing
Help with appeals and re-authorizations
Ongoing support throughout your entire care journey

Your family is never alone—we guide you from day one.

Financial Options for Families Without Insurance Coverage

If your family is not currently covered for ABA therapy, we offer:

Flexible payment options
Sliding scale programs (availability varies)
Referral to community resources
Guidance on obtaining insurance that covers ABA

Our goal is to ensure that every child can access high-quality ABA therapy, regardless of insurance status.