Does Cigna Cover ABA Therapy? What You Need to Know

DISCLAIMER: While many Cigna plans cover ABA therapy, eligibility and approval are not guaranteed. Cigna’s latest guidance on ABA therapy coverage (valid through 12/25) can be obtained here.

If you have health insurance with Cigna and are wondering whether ABA therapy is covered in your plan, this article should help you find out.

If you’re thinking of switching to Cigna insurance and want to confirm that they will cover the ABA therapy you currently have or need, we have a section on that too.

Below, we summarize Cigna’s eligibility criteria for ABA therapy, conditions for coverage, and explain what might be covered under your policy. We’ll also look at frequently asked questions about Cigna’s coverage, such as pre-authorizations, waiting periods, out-of-network providers, and more.

First thing’s first…

We Provide ABA Therapy for Cigna Clients in Multiple States

At Blue ABA, we have helped many clients with Cigna get ABA therapy. We can help you get started even if:

• You’re not sure which Cigna policy you have
• You’re not sure what’s covered 
• You can’t find your diagnosis paperwork 
• You can’t find your Cigna ID card 

In these situations, families simply sign a release form so that we can contact their doctor and insurance company on their behalf to obtain then complete the relevant paperwork.

Most importantly, we have no waiting list for ABA therapy services. If you are eligible for Cigna services, we can start the process of establishing ABA therapy immediately.

To see how we can help, enter your details below for a free, no-obligation consultation:

First, If You’re A Cigna Customer

Finding out exactly what level of ABA therapy your policy covers should be easy when you call Cigna directly using the number on the back of your Cigna Healthcare ID card. If you don’t have a card (or you can’t find it), try their Behavioral Health Benefits line on: 1 (800) 433-5768

After you’ve given your policy number, they should be able to advise you on the process for getting started with ABA therapy.

Just note that it is unlikely this person will be able to tell you how many hours of ABA therapy your child is eligible to have covered. The number of hours won’t be known until a BCBA has completed an ABA Assessment for your child and written a treatment plan. In general, and according to their Coverage Policy, when all of the eligibility criteria are met, Cigna will provide coverage for the hours of therapy that are recommended in the treatment plan.

If You’re Thinking of Switching to Cigna

If your child currently receives ABA therapy, you’re thinking of switching to Cigna, and wondering whether you’ll be covered, a helpful first step is to speak to your current ABA therapy provider about whether they work with Cigna. If they do, they should have the processes in place to submit the correct paperwork, prove eligibility for your child and get started with services.

If your ABA therapy provider does not currently work with Cigna, it may still be worth giving Cigna a call to ask them, should you switch, would they consider covering your ABA therapy services with this provider. 

The Steps to Obtaining ABA Therapy With Cigna

As their coverage policy explains, the steps to getting ABA therapy through Cigna, in the most general sense, are:

1. Obtain an ASD diagnosis
2. Complete an ABA Assessment
3. Obtain a Treatment Plan

These steps are relatively standard and will be a part of obtaining ABA therapy through any insurance provider. To expand slightly on each step:

Obtaining an ASD Diagnosis

According to Cigna’s policy, your child will need an Autism diagnosis

“based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) by a healthcare professional who is licensed to practice independently and whose licensure board considers diagnostics to be within their scope of practice”.

This is the standard criterion for ASD diagnosis, and is typically done by your child’s pediatrician or primary care physician. If, for some reason, you can’t obtain a diagnosis from a pediatrician or PCP, there are other healthcare professionals who can make the diagnosis and meet Cigna’s criteria above, that we have listed here.

TIP: After obtaining a diagnosis, keep the paperwork stored safely and easily accessible, ideally in digital format and hard copy. This paperwork will be requested at various stages in the process of obtaining ABA therapy, and the quicker you can pull it out, the easier things will be. 

Complete an ABA Assessment

Once you have a diagnosis, you can call Cigna to request an ABA assessment. In this assessment, a Board Certified Behavior Analyst (BCBA) will observe your child’s behavior and determine their specific needs for ABA therapy. 

According to their policy, Cigna will help you find a Board Certified Behavior Analyst (BCBA) to perform this assessment. Usually, they will send you a list of providers to choose from, allowing you to select the option that is most convenient or available.

Obtain a Treatment Plan

After your ABA assessment is complete, the next step in getting ABA therapy with Cigna is a treatment plan. Again, this is a standard step required by any insurance company.

Usually performed by the same BCBA (or at least the same ABA therapy provider), a treatment plan documents the goals, techniques and schedule that will guide your child’s ABA therapy. Per Cigna’s policy, the treatment plan will include items such as:

• “Clearly defined and measurable goals designed to target specific behaviors and skills”
• “The method in which progress will be measured”
• “baseline data […] with dates reported from when the data were collected for all behaviors and skills identified for intervention”. That is, a measurement of your child’s current behaviors against which progress can be measured.

And more.

According to Cigna’s policy, once your child has a Treatment Plan, they can begin ABA therapy with the chosen provider.

Autism Diagnosis: Who Can Diagnose Autism? | How Long Does Diagnosis Take? | The Benefits of Diagnosis | Steps to Take After a Diagnosis

ABA Assessments: Why an ABA Therapy Assessment is a Crucial Step

Treatment Plans: Forthcoming

Challenges That Some Families Face

As with ABA therapy through any insurance company, delays in this process are possible. Most commonly, families can face delays in obtaining an ABA assessment or treatment plan when the in-network providers in their area do not have availability.

I must emphasize again here that if you are a Cigna client facing a lack of availability from ABA providers in your area, please reach out to us. We have no waiting list for ABA assessments, treatment plans or one-on-one therapy at the moment and can help you get ABA therapy established quickly.

Frequently Asked Questions about Cigna’s ABA Therapy Coverage

Does Cigna cover ABA therapy for all children with autism spectrum disorder (ASD)?

While there may be some limitations regarding the age of treatment, many states and insurance plans allow for coverage of ABA sessions up to 21 years of age, so long as treatment is continually considered medically necessary. Families need to check with their specific insurance plan and state regulations to understand the full details of their coverage and any age-related restrictions.

How many ABA therapy sessions does Cigna cover?

Most ABA treatment plans give providers a certain number of pre-approved hours over six months. Every six months, BCBAs reassess the client and send re-authorizations to insurance for approval. So long as the treatment plans continue to be updated and approved, sessions are covered continually over each six-month period.

Does Cigna cover out-of-network providers for ABA therapy?

Out-of-network coverage depends on the type of plan a family has, so contacting Cigna directly is your best option to determine if an out-of-network provider can offer services.

In many cases, Cigna can cover ABA therapy with out-of-network providers, but this is highly dependent on the client’s individual case, and considers factors like the availability of in-network providers in the area, the client’s need, level of coverage and more. The first step, if you’re considering an out-of-network provider for ABA therapy, is to contact Cigna to ask.

Is there a waiting period before coverage for ABA therapy begins with Cigna?

Waiting periods for ABA therapy are determined by the providers, rather than the insurance companies. Regardless of the insurance company, families face waiting periods when the ABA therapy providers that are in-network with their insurance company do not have availability. 

Note that this is not the same as a “waiting period for coverage”. With Cigna, like other insurance companies, you will not have to wait to receive coverage once ABA therapy begins.

Does my child need pre-authorization before starting ABA therapy with Cigna?

In nearly all cases with most insurance companies and plans, pre-authorization is required before starting therapy.

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