Our Team of Autism Insurance Experts
Founded by parents of an autistic child, we understand the unique challenges parents and caregivers face when finding the right therapy option for their child, as well as navigating autism insurance and how to pay for the treatment. At Lighthouse Autism Center, we have a dedicated team of Insurance Specialists who are here to help. Each family is paired with an Insurance Specialist who will help them navigate each step of the insurance process. From determining costs, securing access to grants and waivers, and understanding the complexities of insurance for autism, they will handle it all for you so you can worry about what is most important: caring for your child.
How We Help
If you are just beginning the search for the right treatment program for your child, we understand that the various laws and guidelines are often unfamiliar and confusing. Each state has different mandates, rules, and regulations regarding autism insurance coverage. To view your state’s unique autism and insurance mandate, click here.
Our trained staff will contact your insurance company to verify coverage for ABA services. Any denied authorizations are appealed to ensure we are able to secure access to services for your child.
We complete any and all necessary paperwork that your insurance company requires for every re-authorization period, which typically happens every six months.
Your insurance is billed directly, and we will work to resolve any denied claims.
Insurance FAQ
- A provider renders a service to a patient and logs the type of service they performed as well as the duration.
- The provider submits those services and duration of services to the patient’s insurance carrier as a claim.
- The insurance carrier will determine if the patient has any responsibility for payment within 30-45 calendar days.
- If the patient has not yet satisfied their deductible or out-of-pocket maximum, the insurance carrier will set out deductible, copay, or coinsurance amounts as patient responsibility for payment.
- When a patient has not met their deductible, the insurance carrier will pay 0% of the claim. This means that 100% of the amount will be the patient or guarantor’s responsibility to pay.
- Once the patient’s deductible has been met, the patient will still have an out-of-pocket maximum to satisfy. This means that the patient or guarantor will be responsible for their coinsurance or copay amount.
- How it works: If your health plan’s deductible is $1,500, you’ll pay 100% of eligible health care expenses until the bills total $1,500. After that, you share the cost with your health plan by paying coinsurance or a copay.
- After the patient’s deductible has been satisfied, the insurance carrier will share the costs of the healthcare services.
- Coinsurance is typically a percentage of the amount that the insurance carrier allows to be charged for services.
- How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying all costs, you and your health plan share the cost. For example, your health plan pays 70%. The 30% you pay is your coinsurance.
- A copay is a fixed amount that a patient pays for healthcare services. This amount can vary depending on the type or location of service.
- How it works: Your health plan determines what your copay is for different types of services and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible and when you owe coinsurance.
- Once your insurance carrier processes your claims within 30–45* days, they will determine your patient balance.
- *This is a general timeframe; not all claims will be processed within 30–45 days.
- After your insurance carrier has assigned a balance to you, Lighthouse will mail you a statement on a monthly basis.
- No! Lighthouse understands that healthcare is expensive, and we offer flexible payment plans that you can afford. Plans are offered on a weekly, bi-weekly, or monthly basis.
- When you receive your statement in the mail, follow the instructions at the bottom of the statement to set up a payment plan online or call one of our dedicated patient statement representatives.
-
- COBRA: This is a plan purchased through your previous employer. Often, the paperwork can take weeks to arrive at the previous employer’s HR department. We recommend reaching out to the HR department directly to see if you can pick up a copy or have one emailed to you.
- If you can purchase COBRA, please send us a copy of the completed paperwork or have the center scan a copy to send to Insurance.
- Additionally, the premium associated with COBRA will be charged. Please also send us payment verification — this could be an email, screenshot, or copy of the check.
- Marketplace Plans: Because there was a loss of health coverage, this is a Qualifying Life Event to allow you to sign up for a marketplace plan.
You can enroll at healthcare.gov/enroll
- COBRA: This is a plan purchased through your previous employer. Often, the paperwork can take weeks to arrive at the previous employer’s HR department. We recommend reaching out to the HR department directly to see if you can pick up a copy or have one emailed to you.
What insurance do you accept? What does insurance cover?
Lighthouse Autism Center accepts nearly all major insurance types, though there may be some variation from center to center. Our insurance team will assist you with navigating your insurance coverage and questions.
- Indiana Medicaid
- Aetna
- IU Healthcare
- Cigna
- UMR
- And others
- Priority Health
- Michigan Medicaid
- And others
- Health Alliance
- BCBS IL
- IL Ambetter (Centene)
- And others
- Iowa Medicaid
- Wellmark
- Highmark
- Cigna
- And others
- NE BCBS
- NE Medicaid Total Care
- NE Medicaid Molina
- IA Medicaid (at some locations)
Understanding Eligibility for Autism Grants
The requirements for receiving autism grants can differ based on the specific grant and the organization offering it. Some grants may need families to meet specific income or residency criteria, while others might be open to all families, regardless of their financial situation.
Tips for Applying:
Each organization has its own grant application process, which can be confusing if you’re applying for multiple grants simultaneously. Here are some tips to help you through the process.
Guides and Tips for Writing Proposals:
- Start by reading the entire application. Make a list of the documents you’ll need, like tax statements, diagnostic reports, and Individualized Education Plans (IEPs). A checklist will help you stay organized and meet all deadlines.
- Choose your applications wisely. Many autism organizations only fund specific types of therapies and services. It’s best not to waste your time on applications that won’t cover what you need.
- Add a personal message. Some applications may request information about your child and why you’re seeking their services. Consider including a photo of your child and a recommendation letter if the application permits.
National ABA Therapy Grants
UHCCF is a 501(c)(3) charitable organization that provides medical grants to help children gain access to health-related services not covered, or not fully covered, by their family’s commercial health insurance plan. You DO NOT have to have United Healthcare Insurance to qualify. Grants are available for medical costs incurred within 60 days of the time UHCCF determines the application to be complete. Grants are good for one year following the month in which they are approved.
Grant Amounts:
The amount awarded to an individual within a 12-month period is limited to $5,000. Awards to any one individual are limited to a lifetime maximum of $10,000.
Who is Eligible:
- Must be medically insured by a commercial health plan, either through an employer or
individually purchased. - Must be under the age of 16 years old*
- *Children aged 3-6 for a one-time grant to help cover the cost of ABA therapy
- Child must have a Social Security Number issued by the Social Security Administration.
- Income
- Family Size of 2– $55,000 or less
- Family Size of 3– $85,000 or less
- Family Size of 4– $115,000 or less
- Family Size of 5 or more– $145,000 or less
Expenses covered include:
- UHCCF is happy to consider children aged 3-6 for a one-time grant to help cover the cost of ABA therapy. We are unable to include ABA therapy as a grant service for children younger than 3 or older than 6, or multiple grants for ABA for the same child.
- Speech and occupational therapy
Expenses not covered include:
- Dental procedures
- Educational expenses, including day camps
- Home and vehicle expenses
- Travel and lodging
Autism Care Today is a national nonprofit 501(c)(3) organization whose mission is to raise awareness and provide treatment services and support to families to help their children with autism be able to achieve their full potential. There are quarterly grant deadlines.
Grant amounts:
$100 to $5,000
Who is eligible:
Priority is given to families with multiple autistic children, military families, and those with an annual income under $100,000.
Expenses covered include:
- Applied behavior analysis (ABA)
- Speech and occupational therapy
- Biomedical testing
- Nutritional supplements
- Assistive technologies (iPads, communication apps)
- Safety equipment (safety fencing, GPS tracking devices, and autism service dogs)
- Social skills groups
- Disability summer camps
Expenses not covered include:
- Transportation requests (cars, car repair, transportation passes, air travel)
- Hyperbaric oxygen therapy
- Personal needs (rent, utilities, family vacations)
Autism Speaks Cares offers limited assistance for individuals and families affected by a catastrophic life event or natural disaster. The grant program helps families cover critical
expenses related to the welfare of the family member with autism experiencing a devastating life event or natural disaster. Considered on a case-by-case basis. DOES NOT fund reoccurring monthly expenses such as rent, mortgage, utility, or car payments.
Grant Amounts:
Determined on a case-by-case basis.
Who is Eligible:
Families affected by autism during natural disasters and other tragic life events.
Expenses covered include:
Determined on a case-by-case basis.
Expenses not covered include:
Determined on a case-by-case basis.
CARE Grant Program is for helping families with medication, autism diagnosis/evaluation,
therapy session (including speech, OT and ABA,) autism summer camps. Please note that all
grants awarded are paid directly to the vendor or service provider to pay for tuition, supplements, medication, medical evaluation, testing, therapies, etc.
Grant Amounts:
Not specified.
Who is Eligible:
Families of children with autism (ages not specified), residing in USA with income less than
$75,000/year.
Expenses covered include:
- Applied behavior analysis (ABA)
- Speech and occupational therapy
- Diagnosis/evaluation services
- Medication
- Autism summer camps
Expenses not covered include:
- Educational expenses
- Home and vehicle expenses
- Travel and lodging
Illinois ABA Therapy Grants
Autism Hero Project seeks to improve the lives of children with autism, people otherwise on the autism spectrum, and their families through providing financial assistance for Applied Behavioral Analysis (ABA) therapeutic services, helping others understand autism-related needs in everyday life, and promoting more than just awareness among communities. We strive to create a world of inclusion, where ALL means ALL.
Grant Amounts:
Autism Hero Project will pay the difference in coverage that covers the applicant’s portion of their insurance premium only—either through the marketplace or an employer. Deadlines for application follow Open Enrollment.
Who is Eligible:
- Must be medically insured by a commercial health plan, either through an employer or individually purchased.
- Must have an updated diagnostic report within the last three (3) years
- Must be a resident of Illinois or Florida
- Applicant’s Household income and size will be taken into consideration (Priority will go to low-income and/or families with multiple dependents on the autism spectrum.)
- Autism hero project medical insurance premiums only. Their grants do not cover deductibles, co-payments, co-insurance or any other out-of-pocket expenses.
- Child must be receiving a minimum of twelve (12) hours of ABA therapy
Expenses covered include:
- Medical health insurance premiums.
Expenses not covered include:
- All other expenses.
Chicago Autism Network’s mission is to strengthen the local autism community by helping those in need find and afford effective autism therapy and support. This grant has a deadline for application.
Grant amounts:
Unspecified.
Who is eligible:
- Must have a permanent address in Illinois
- Must have a current autism diagnosis from an MD or qualified psychologist (screeners and public school evaluations don’t count).
- Must Have a household income lower than or equal to 200% of the federal poverty level.
Expenses covered include:
- Speech Therapy
- Occupational Therapy
- Physical Therapy
- ABA (Applied Behavior Analysis) Therapy
- Dialectical Behavior Therapy
- Cognitive Behavioral Therapy
- Educational/Developmental Therapy
- Social Skills Group
- Therapeutic Day School
- Pharmacotherapy
- Other Psychotherapy
Expenses not covered include:
- Fees
- Late fees
- Registration fees
HIPP Grant (Health Insurance Premium Payment) is a terrific, but lesser-known program run by the state of Illinois that will reimburse families for the cost of private insurance premiums (purchased through your employer or through the Marketplace) for those with Medicaid.
Grant Amounts:
Determined on a case-by-case basis.
Who is Eligible:
- Must currently enrolled with Medicaid
- Must have private health insurance (through your employer or Affordable Care Act Marketplace).
- Must be cost effective (monthly expenditure on health costs must be 2.5x greater than your monthly premium.
- Must be able to show 6 months of EOBs (Explanation of Benefits – the statements from your health insurance showing the cost of your care) demonstrating that you are cost effective.
Expenses covered include:
Medical health insurance premiums
Expenses not covered include:
All other expenses
Get in Touch
Do you have questions about autism ABA therapy and insurance coverage? Contact your local Insurance Specialist or autism insurance resource center to learn more.
