Insurance Verification · Sunshine Behavioral Health Services
Most major insurance plans cover ABA therapy for children with an autism diagnosis under Florida law. Our team verifies your benefits before your first appointment — for free, within 24 hours — so you know exactly what is covered before therapy begins. No surprise bills.
Free
Insurance Verification
No cost to you — ever
24hrs
Verification Time
Most benefits confirmed same day
Florida
Law Requires Coverage
ABA mandated for most plans
$0
To Get Started
No upfront costs to verify
Florida Law & ABA Therapy
Yes. Florida law requires most insurance plans to cover ABA therapy for children with an autism spectrum disorder (ASD) diagnosis. This coverage is mandated under Florida Statute 627.6686 and applies to most fully insured health plans in the state.
Under federal mental health parity laws, insurance companies cannot impose more restrictive benefit limitations on ABA therapy than they do on medical and surgical benefits. This means that if your plan covers other treatments, it must also cover medically necessary ABA therapy at comparable levels.
The coverage requirement applies to children who have received an autism diagnosis. Most plans require a written autism diagnosis from a licensed physician or psychologist before authorizing ABA therapy. Our team helps you gather the documentation needed and submits the authorization request on your behalf.
Florida Medicaid covers ABA therapy for eligible children under 21. If your child is enrolled in Florida Medicaid or a Medicaid managed care plan, ABA therapy is a covered benefit with no or low out-of-pocket cost.
What Florida law covers
✓ ABA therapy for children with ASD diagnosis
✓ All medically necessary ABA services
✓ In-home, school-based, and center-based ABA
✓ BCBA-supervised treatment programs
✓ Parent training as part of ABA program
Florida Statute 627.6686
This is the Florida law that mandates ABA therapy coverage. If your insurer denies coverage, this statute is your first line of appeal. Our team can guide you through the appeals process.
Insurance We Accept
We are in-network or work with most major insurance plans serving families in Miami-Dade, Broward, Palm Beach, and Monroe Counties. Do not see your plan listed? Contact us — we likely work with it.
Government / Medicaid
Covers ABA therapy for eligible children under 21. Low or no out-of-pocket cost for qualifying families.
Medicaid Managed Care
Florida Medicaid managed care plan. ABA therapy covered for eligible members with autism diagnosis.
Medicaid Managed Care
Medicaid managed care plan covering ABA therapy across Southeast Florida counties.
Medicaid Managed Care
Florida Medicaid managed care. ABA therapy benefit available for children with qualifying diagnosis.
Commercial Insurance
One of the most common commercial plans. ABA therapy covered under most BCBS plans with autism diagnosis.
Commercial Insurance
Covers ABA therapy under most Aetna commercial and employer-sponsored plans in Florida.
Commercial Insurance
ABA therapy covered under UHC commercial plans. Authorization required before services begin.
Commercial Insurance
Covers ABA therapy for children with autism under most Cigna commercial health plans.
Commercial Insurance
ABA therapy benefit available under most Humana commercial and Medicare Advantage plans.
Commercial Insurance
Florida’s largest health insurer. ABA therapy covered for children with autism under most plans.
Commercial Insurance
Florida-based health plan covering ABA therapy for qualifying members with autism diagnosis.
Commercial Insurance
ABA therapy covered under Oscar individual and family plans in Florida.
Do not see your plan? Contact us and we will verify it — we work with many additional plans not listed here.
How It Works
We handle the entire insurance verification process for you. Here is exactly what happens from your first contact to your child’s first session.
1
Call us, fill out our contact form, or schedule online. Tell us your insurance plan and we get started right away.
2
Our team contacts your insurance company directly, confirms your ABA therapy benefits, checks your deductible and co-pay, and reviews prior authorization requirements.
3
Within 24 hours, we call you with a plain-English summary of your coverage — what is covered, what you will pay, and what the next steps are. No jargon.
4
For plans that require prior authorization, we submit the request on your behalf using your child’s diagnosis and clinical documentation. We handle all the paperwork.
Insurance Denials
Insurance denials for ABA therapy happen, but they are often overturned on appeal. Under Florida law and federal parity rules, your insurer cannot arbitrarily deny medically necessary ABA therapy for a child with an autism diagnosis.
If your claim is denied, here is what to do. First, request the denial in writing and ask for the specific reason. Most denials are for administrative reasons — a missing diagnosis code, a prior authorization that was not submitted correctly, or a documentation gap. These are fixable.
Second, file a formal appeal. Your insurance plan is required to provide an internal appeals process. Include a letter of medical necessity from your child’s diagnosing physician and a clinical summary from the BCBA. Our team will help you prepare this documentation.
Third, if the internal appeal is denied, you can file an external appeal with an independent reviewer. You can also file a complaint with the Florida Office of Insurance Regulation. Our team can guide you through every step of this process.
Submit the authorization request with complete diagnosis documentation and a BCBA letter of medical necessity. We submit this for you.
Ensure the diagnosis code on the claim matches the code on your child’s diagnosis letter exactly. We verify this before every submission.
Appeal with a detailed clinical summary from the BCBA explaining the child’s diagnosis, current functioning, and how ABA therapy addresses medical necessity. Contact us for help.
Contact us to confirm our network status with your specific plan. We are in-network with most major Florida plans and can clarify your benefits directly.
Here are clear answers to the insurance questions families across Southeast Florida ask us most. If your question is not here, contact us directly.
Yes. Most insurance plans require a formal autism spectrum disorder (ASD) diagnosis from a licensed physician or psychologist before they will authorize ABA therapy. If your child does not yet have a diagnosis, the first step is a developmental evaluation. Contact us and we can help guide you through this process.
Prior authorization means your insurance company must approve ABA therapy before services begin. Most commercial plans and Medicaid managed care plans require it. We handle the entire prior authorization process for you — submitting the clinical documentation, following up with the insurer, and appealing if needed.
This depends on your specific plan — your deductible, co-insurance rate, and co-pay structure. We explain all of this in plain language during our verification call before any services begin. Most families with Medicaid pay little or nothing. Commercial plan members typically have a co-pay per session after meeting their deductible. We will never start services without giving you a clear picture of your costs first.
If you do not have insurance or your plan does not cover ABA therapy, we can discuss private-pay options and help you explore alternative coverage pathways. Florida Medicaid covers ABA therapy for eligible children and has no income ceiling for children with disabilities in some programs. Contact us to discuss your specific situation.
Yes. Denials are common and many are overturned on appeal. Under Florida law and federal mental health parity rules, your insurer cannot arbitrarily deny medically necessary ABA therapy. We help families gather documentation, write appeal letters, and navigate the appeals process step by step. Contact us as soon as you receive a denial letter.
Yes. Florida Medicaid covers ABA therapy as a covered benefit for eligible children under 21 with an autism spectrum disorder diagnosis. This includes Florida Medicaid fee-for-service and all Medicaid managed care plans — Sunshine Health, Molina Healthcare, Simply Healthcare, Humana, and others. Contact us to verify your child’s Medicaid ABA therapy eligibility.
Contact us today and we will check your ABA therapy benefits within 24 hours at no cost to you. No paperwork, no phone hold times — we handle it all.
