What your Aetna plan covers should never be a mystery.
We are out of network with Aetna, and for many families that is a smaller hurdle than it sounds. Many Aetna plans include out-of-network benefits for ABA. Before your child's first session, we verify your exact benefits for free and tell you what your plan pays, in plain English.
Does Aetna cover ABA therapy in Maryland?
Usually, yes. Maryland's habilitative services law, Insurance Article 15-835, requires health plans regulated by the state to cover habilitative services for children, and for a child with an autism diagnosis that benefit includes ABA therapy. If your Aetna plan was purchased in Maryland, on the individual marketplace or through an employer that buys a fully insured plan, that law most likely applies to you.
Here is the part we want you to know up front: Terrapin ABA is out of network with Aetna. That is not the roadblock it sounds like. Many Aetna plans include out-of-network benefits that help pay for ABA once a separate out-of-network deductible is met, often as a percentage of allowed charges. Whether that works for your family depends on your specific plan, and plans vary; self-funded employer coverage in particular writes its own rules under federal law.
That is why we start with verification, not paperwork for you to decode. We contact Aetna, pull your actual out-of-network benefits, and tell you exactly what your plan pays before anything begins. We also carry the claims side, preparing and submitting the paperwork your plan needs, so you are never the go-between with the insurance company.
- A free check of your out-of-network Aetna benefits before any commitment
- Plain-English answers about deductibles, coinsurance, and what your plan pays
- Authorizations, claims, and paperwork handled by our team
The insurance work is our job, not yours.
Free benefits verification
Tell us you have Aetna and we take it from there. We contact the plan, confirm your out-of-network ABA benefits, and report back on deductibles, coinsurance, and what your plan pays, in plain English.
Authorization
Many Aetna plans require approval before ABA starts, even for out-of-network care. We gather your child's diagnosis paperwork, submit the request where your plan requires it, and follow it through.
Claims and paperwork
We prepare and submit the claims paperwork for every session. On your explanation of benefits you will see CPT codes 97151 for the assessment, 97153 for one-on-one sessions, 97155 for BCBA plan direction, and 97156 for caregiver training.
Six-month renewals
Authorizations run in six-month cycles. We track the dates, document your child's progress, and submit each renewal so care continues without a gap on your end.
What Aetna families ask us.
One call to us beats hours on hold with an insurance company.
Send us your Aetna member information and we will do the verifying, the explaining, and the paperwork. The benefits check is free, and you decide what happens after.