ABA therapy and Ambetter

What is covered

Ambetter generally covers ABA for an autism diagnosis when it is medically necessary and prior authorized. Your plan document decides the specifics.

Ambetter is the marketplace brand used by Centene's health plans. Marketplace plans are state regulated, so your state's autism mandate applies to them.

Ask them: Does my Ambetter plan require prior authorization for ABA?

Self-funded or fully insured?

Ask your employer which yours is. Fully insured plans follow your state's autism mandate; self-funded plans follow federal rules instead. Many cover ABA either way.

Before your first session

• Confirm the agency is in network, not just willing to bill.
• Ask how many authorized hours, over what dates.
• Ask your copay per session.
• Get the reauthorization date in writing.