How to navigate the insurance process when starting ABA Therapy

You’ve just received the Autism Diagnosis for your child and now you’re wondering what the next steps should be; paying for it included. 

ABA Therapy is covered by most insurance policies. Westside Children’s Therapy offers ABA Therapy, as well as Diagnostic Evaluations to receive the Autism Diagnosis. Westside also accepts 15+ different insurances to help pay for ABA Therapy. 

On average, insurance will cover 90%-95% of total expenses. ABA Therapy can be very expensive overall, so without the help of insurance, it may be difficult to pay out of pocket. 

The percentage that you are required to pay comes in the form of deductibles, copays, if you have one, and coinsurance. 

A deductible is the amount you must pay before insurance covers your portion. A copay is a daily or per-service fee your insurance plan charges when you come for therapy. Coinsurance is the amount left over your insurance does not cover after your plan’s deductible is met. 

These will be your only out-of-pocket costs and most plans set a maximum of what you have to pay out of pocket. Insurance plans in Illinois typically have an out-of-pocket maximum between $1,500 and $3,000, which is what most people pay in total for ABA Therapy. This doesn’t include monthly premiums you may have.

ABA Therapy can add up quickly because most kids receive between 10-30 hours of therapy each week. With the number of hours an average child receives, an out-of-pocket is met at a fast rate. 

Insurance plans typically cover the least amount at the beginning of the year. This leaves you with higher costs, but you will quickly pay your deductible and out-of-pocket costs right away with insurance covering the rest of the year. 

Here is an example of an ABA patient with an average insurance plan:

The child receives 20-25 hours of ABA Therapy on a plan with a $3,000 out-of-pocket maximum. The first week costs approximately $1,500, and in the next week decreases to $375.  This shows the deductible was met and insurance has started paying their share.

By week 5, after paying approximately $375 each week, the maximum is met and brings weekly costs to $0 for the rest of the year. 

Westside Children’s Therapy offers payment plans that help families pay a consistent cost every week throughout the year. This eliminates the shock factor of paying so much at the start of the year. 

You can estimate what you would pay for ABA Therapy by looking at your plan’s maximum out-of-pocket costs. The lower your out-of-pocket amount is, the lower you would owe for ABA Therapy. 

These are just estimated as each plan has different copays, deductibles, coinsurance percentages, out-of-pocket maximums, plan exclusions or limits, and appointment frequencies. Westside can help you analyze your plan and get a better picture of what is owed.

ABA at Westside Children’s Therapy is always 1-to-1 and allows your child’s therapy plan to be specifically designed to meet their needs. There may be two kids who have the same goal but take different routes to meet them. 

Westside’s ABA programs also provide group activities where similarly-aged children can work together, but your child’s therapist does not leave their side. A group of five children may be working together, but each has their own therapist guiding their session. 

You can get started at Westside by visiting or calling (815) 469-1500.