What to Do When Your ABA Therapy Provider Is Dropped by Insurance

Nothing is more stressful than receiving notice that your child's ABA therapy provider has been dropped from your insurance network -- or that your insurer has stopped covering ABA services without warning. This is happening to families across the country right now. In Arizona, UnitedHealthcare, Mercy Care, and Arizona Complete Health dropped two major ABA providers from their networks in early 2026, affecting hundreds of families. In Nevada, UnitedHealth's local companies began denying coverage or imposing sudden co-pay hikes of up to $80 per session.

If this has happened to your family, here is exactly what to do.

Why Do Insurers Drop ABA Providers or Reduce Coverage?

Insurance companies remove ABA providers from their networks or restrict coverage for several reasons:

• Cost management: ABA therapy is expensive, and Medicaid and commercial insurers are under increasing pressure to reduce costs as autism diagnoses rise and ABA utilization grows
• Network restructuring: Insurers periodically review their provider contracts and may drop providers who do not meet new billing requirements, credential standards, or rate negotiations
• Medical necessity reviews: Some insurers are applying stricter clinical review processes, scrutinizing whether a child meets their specific criteria for ABA therapy
• Medicaid rate disputes: States and managed care organizations are cutting ABA reimbursement rates, and some providers respond by leaving Medicaid networks

Whatever the reason, the impact on your child's care is the same. Here is how to protect it.

Step 1: Get the Decision in Writing

Before you do anything else, request written documentation of the coverage change or network removal. If your insurer notified you verbally, ask for a written denial or network change notice. This document establishes your right to appeal and sets the clock on your appeal deadlines.

Key questions to ask in writing:

• What is the effective date of the network change or coverage denial?
• What is the specific reason for the denial or network removal?
• What is the appeals process and deadline?
• Is there an expedited appeals process given medical necessity?

Step 2: Request Continuity of Care

Many states require insurance plans to provide a transitional "continuity of care" period when a provider is dropped from the network. During this transition period, your insurer must continue covering services at in-network rates while your child transitions to a new provider.

Call your insurer and ask specifically:

• "Does my plan include a continuity of care provision for ABA therapy?"
• "How long can my child continue with the current provider at in-network rates?"

Continuity of care protections vary by state. California, New York, and other states have strong continuity protections. Even if your state does not mandate it, your insurer may offer it voluntarily -- especially for ongoing behavioral health treatment. Always ask.

Step 3: File a Formal Appeal

If your coverage was denied or if continuity of care is refused, you have the right to appeal. The appeals process has multiple levels:

Level 1: Internal Appeal

Submit a written appeal to your insurance company within the deadline stated in your denial letter (typically 30 to 180 days). Include:

• A letter from your child's ABA provider and BCBA explaining why services are medically necessary
• A letter from your child's diagnosing physician or developmental pediatrician
• Recent progress data showing your child's response to ABA therapy
• Your child's treatment plan and goals

Level 2: External Review

If your internal appeal is denied, you can request an external review by an independent organization. Under federal law (the Affordable Care Act), most health plans must offer external review. The external reviewer's decision is typically binding on the insurer. External reviews for urgent medical situations are often completed within 72 hours.

Expedited Appeals for Urgent Situations

If your child's ABA therapy is being interrupted and you believe this presents an immediate health risk, request an expedited appeal. Insurers must respond to expedited appeals within 72 hours or less.

Step 4: Find In-Network ABA Providers

While your appeal is pending, start searching for an in-network ABA provider so you are not caught without care if the appeal takes time.

• Search ABA Navigator: Use our provider directory to find ABA therapy providers in your area who accept your specific insurance plan
• Call your insurer: Ask for an up-to-date list of in-network ABA providers who are currently accepting new patients -- verify this directly with each provider, as insurer directories are frequently outdated
• Ask your current provider: Many providers maintain relationships with other ABA clinics and can make a direct referral to a colleague who has openings

When calling potential new providers, be specific: "I need an in-network provider for [insurer name], specifically for [plan name]. Are you currently accepting new clients under that plan?"

Step 5: File a Complaint with Your State Insurance Commissioner

If your insurer is not following state law, is slow to respond to your appeal, or is applying coverage restrictions that appear discriminatory, file a formal complaint with your state's insurance regulatory agency. This is often the most powerful tool available to families.

State insurance commissioners have the authority to investigate insurers, require them to explain coverage decisions, and impose penalties for violations of insurance law. Complaints are taken seriously, especially when they involve children's autism services.

To find your state's insurance commissioner:

• Search "[your state] office of insurance commissioner" or visit the National Association of Insurance Commissioners (NAIC) at naic.org
• Many states have an online complaint portal that takes less than 15 minutes to complete

In Nevada, for example, families who complained to the Nevada Division of Insurance about UnitedHealth's 2026 coverage changes prompted state officials to investigate compliance with Nevada's autism insurance mandate.

Step 6: Know Your Federal Protections

Several federal laws protect your child's access to ABA therapy:

Mental Health Parity and Addiction Equity Act (MHPAEA)

Federal law requires that insurance plans offering mental health or behavioral health benefits cannot impose more restrictive limits on those benefits than they apply to comparable medical or surgical benefits. If your insurer covers knee surgery with no visit limits but caps ABA therapy at 30 hours per week, that may be a parity violation.

ACA Essential Health Benefits

Plans sold on the ACA marketplace must cover mental health and behavioral health services as essential health benefits. ABA therapy is considered a covered service under most ACA plans for children with autism diagnoses.

Medicaid EPSDT

If your child is on Medicaid, the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires coverage of any medically necessary treatment for children under 21, including ABA therapy. Medicaid cannot legally deny medically necessary ABA therapy for children under 21 solely because of cost.

What to Do If You Are in a State Cutting Medicaid ABA Coverage

A growing number of states are reducing ABA reimbursement rates or imposing new restrictions on Medicaid-funded ABA therapy. Affected states in 2026 include Georgia, North Carolina, Nebraska, and Indiana. If you are affected:

• Contact your state legislator. Individual stories from families are powerful -- legislators respond to constituent advocacy
• Join advocacy organizations. The Autism Society of America, Autism Speaks, and state-level autism advocacy groups are actively fighting Medicaid cuts. They can provide guidance and amplify your voice
• Ask your provider about private pay rates. Some providers offer sliding-scale fees for families who lose Medicaid coverage, especially during a transition period
• Explore school-based services. Under IDEA, public schools must provide Free and Appropriate Public Education (FAPE), which may include ABA-related behavioral support services in the school setting

Finding a New ABA Provider Quickly

Provider waitlists are long in many areas, but some providers do have openings -- especially for specific age groups, service settings, or insurance types. The key is to cast a wide net immediately, rather than waiting to hear back from your first choice.

Tips for faster placement:

• Add yourself to multiple waitlists at the same time
• Ask about in-home or telehealth options, which often have shorter wait times than center-based care
• Ask if the new provider can offer parent training while you wait for direct services to begin
• Provide your child's updated assessment and treatment history so the new provider can onboard faster

Use ABA Navigator's directory to search by insurance, location, and service type. Contact multiple providers in parallel -- do not wait to hear back from one before contacting others.

Find In-Network ABA Therapy Providers Near You

Navigating insurance appeals, finding new providers, and advocating for your child takes time you may not have. ABA Navigator is here to help. Use our provider directory to find qualified ABA therapy providers near you who accept your insurance.

Find In-Network ABA Therapy Providers on ABA Navigator