Diagnosis Eligiblity
ABA therapy is a medical treatment covered by health insurance — similar to physical therapy or speech therapy. Because your insurance pays for treatment, they determine which autism diagnoses qualify for coverage.
Requirements differ by insurance type:
Diagnosis must come from a Center of Excellence (COE) — a state-designated provider approved to conduct ASD evaluations for Apple Health coverage.
COE evaluations use validated diagnostic tools such as:
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Autism Diagnostic Observation Schedule (ADOS)
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Autism Diagnosis Interview (ADI)
A screening alone (like M-CHAT) does not qualify.
Private Insurance
Requirements vary by insurance company and plan. Generally, private insurers accept diagnoses from a broader range of licensed providers, including:
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Psychologists
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Developmental Pediatricians
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Neurologists
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Psychiatrists
Contact your insurance to confirm:
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Which providers they accept for ASD diagnosis
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Which diagnostic tools are required
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Whether prior authorization is needed