ABA therapy has helped thousands of children with autism gain life-changing skills, but a disturbing trend is emerging in insurance-funded services:
Denials are being issued without reviewing the child’s actual progress.
Doctors conducting “clinical reviews” admit they are NOT reading reports.
Families are left scrambling to appeal these decisions, forced to terminate services until the insurance company allows them to resume.
Why Is This Happening?
Insurance companies are moving toward value-based care (VBC), a model that focuses on "cost efficiency" rather than individualized treatment. Instead of looking at what your child needs, insurers are using standardized benchmarks to decide whether therapy is “worth” paying for.
To make matters worse, the BCBAs working for insurance companies—the same professionals trained to advocate for therapy—are now the ones denying it.
How Does This Affect Your Child?
When ABA therapy is denied without a real review, families are left with:
🚨 An immediate stop to therapy. Your child’s services may be cut off overnight.
🚨 Regression in skills. Children who were making progress may lose essential skills due to service gaps.
🚨 A long, exhausting appeal process. Parents are forced to fight denials through a slow, bureaucratic system that leaves children without support for months.
What Can You Do?
Parents do not have to accept these denials without fighting back. Here’s how you can take action:
✅ Request a Written Explanation for Any Denial – Ask for an itemized reason why your child’s ABA therapy was denied. Do not accept vague responses.
✅ File an Appeal Immediately – You have the right to appeal, and in many cases, your child can continue services while appealing.
✅ Report This to Your State Medicaid Office .
✅ Contact Your Legislators – Many states have laws protecting ABA therapy, but these protections mean nothing if insurance companies are allowed to deny care without oversight.
✅ Join Parent Advocacy Groups – Organizations like the Autism Legal Resource Center and state ABA coalitions can help you fight unfair denials.
Your Child Deserves Better – Let’s Make a Change
ABA therapy is not a privilege—it’s a medically necessary service that helps children gain independence and essential life skills. No child should lose access to therapy because of an unfair, unreviewed denial.
If this is happening to your child, don’t stay silent. Fight back, file complaints, and demand change.
Together, we can hold insurers accountable.
Has your child’s ABA therapy been unfairly denied? Share your story—we are stronger together.
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