Does Insurance Cover ABA Therapy in Nevada?
Find out what Nevada parents need to know about ABA coverage, including the exact questions to ask.
How ABA Coverage Works in Nevada
If you have a private health plan in Nevada, whether it covers ABA therapy depends on the type of plan you have. Nevada has a state autism mandate, but it only applies to fully insured plans. That means plans regulated by the state, typically those you buy on your own or get from a small employer.
If your employer self-funds its health plan, the state mandate doesn't apply. Self-funded plans are governed by federal law (ERISA), and they are not required to follow Nevada's mandate. Many self-funded plans still cover ABA, but it's not guaranteed.
This is why two families working at the same company can get different answers. One might have a fully insured plan, the other a self-funded one. Your HR department can tell you which type you have.
The Exact Question to Ask HR
Before you call your insurance company, ask your HR department one question: "Is our health plan fully insured or self-funded?" That answer tells you whether Nevada's mandate applies.
If it's fully insured, the state mandate requires coverage for autism treatment, including ABA. If it's self-funded, you're not guaranteed coverage, but many plans still include it. Either way, ask for the plan's Summary of Benefits and Coverage (SBC) and look for the ABA or autism section.
What to Ask Your Insurance Company
Once you know your plan type, call the number on your insurance card and ask these exact questions:
Does my plan cover applied behavior analysis (ABA) therapy for autism?
Are there any limits on the number of visits, hours per week, or total annual cost?
Do I need a prior authorization? If so, what forms and documentation are required?
Is there a deductible or copay for ABA therapy?
Which providers are in-network for ABA?
- Ask for the name of the person you spoke to and a reference number for the call.
- Get everything in writing, either via email or a mailed letter, before you start services.
Prior Authorization and Documentation
Most insurance plans require prior authorization before they'll cover ABA. That means you need approval before starting therapy, or you could be stuck with the full bill.
The process usually starts with a diagnostic evaluation. Your doctor or a qualified professional must provide a formal autism diagnosis, often using the ADOS-2 or similar tool. Then, the ABA provider submits a treatment plan to your insurance, including goals and estimated hours.
Your insurance will review and either approve, deny, or ask for more information. The whole process can take a few weeks, so start early. Ask your ABA provider if they handle the paperwork; most do.
What to Do If Your Claim Is Denied
If your insurance denies coverage, you have the right to appeal. Start by reading the denial letter carefully. It will explain the reason and the deadline to appeal, which is often 180 days.
Ask your ABA provider for a letter of medical necessity. That's a detailed explanation of why ABA is needed, written by a qualified professional. You can also ask your doctor to write one.
If the first appeal fails, you can request an external review. In Nevada, that's an independent review by a third party. The denial letter should explain how to request it, or you can call your insurance company and ask.
Nevada Medicaid for ABA
If you qualify for Nevada Medicaid, ABA therapy is covered for children under 21 when it's medically necessary. That's thanks to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which is federal law.
Your Medicaid plan will have its own process for prior authorization. The plan name is on your member card, and you can call the number there to ask about ABA coverage and how to get started.
Medicaid may have different provider networks than private insurance, so check which ABA agencies accept your plan. You can also ask your child's doctor for a referral.
Nevada listings right now
432 ABA agencies across 9 Nevada counties.