A: One possible reason a family based in California might receive a denial is because the mandate requires fully funded plans to cover ABA benefits. If you have a self-funded or federally funded plan, funding is not required and the regional center may continue as the funding source. Reasons for a denial of care in other states typically fall into two categories:
- ABA services are not a covered benefit
- Clinical issues related to the medical necessity requirements not being met or the provider not meeting requirements.
Most states and health plans have an appeal process and the intake specialist will help you begin the appeal process where appropriate.