Does United Healthcare Cover Autism Testing & Therapy Treatment?

Does United Healthcare Cover Autism Testing & Treatment?

Yes, United Healthcare insurance may cover autism services in Tennessee, depending on the specifics of your health plan.

Jump to Section

• Does United Healthcare Cover Autism Testing & Treatment?
• How to Verify United Healthcare Autism Coverage
• What is Autism?
• Is Autism Testing Covered by United Healthcare?
• Are Autism Treatments & Medications Covered by United Healthcare?
• How To Find United Healthcare Autism Testing & Treatment Clinics Near Me?
• How Much Does Autism Testing & Treatment Cost Without Insurance?
• Can Autism Affect My Insurance Coverage?

How to Verify United Healthcare Autism Coverage

Athena Care is in-network with most major insurance plans. To determine the specifics of your United Healthcare autism coverage, contact us below.

Let our highly experienced, expert care coordinators handle the difficulties of contacting your health insurer for more information about your United Healthcare autism coverage. A care coordinator will review your insurance policy and thoroughly explain your options. Rest assured that any information presented or discussed will remain private.

What is Autism?

Autism Spectrum Disorder (ASD) is a developmental disability caused by changes in the brain that impair communication and behavior. As a result, people with ASD may speak, conduct, engage, and learn differently than most people.

Autism is a “spectrum” disorder because people with ASD have a wide range of talents. Some people need a lot of help with everyday tasks, while others can work and live independently.

ASD typically appears before age three and can last the rest of a person’s life; however, symptoms can improve with time. Some children exhibit symptoms before the age of twelve months, while others may not show signs of ASD until the age of 24 months or later.¹ Furthermore, some children with ASD learn new skills and meet developmental milestones until they reach the age of 18-24 months, at which point they discontinue learning new skills or lose the ones they already have.

Some with high-functioning autism may not obtain a diagnosis of ASD until later in life because their symptoms are mild or because they can “hide” them.

Types of Autism

The following are the five major autism spectrum disorders:²

• Asperger’s Syndrome
• Rett Syndrome
• Childhood Disintegrative Disorder (CDD)
• Kanner’s Syndrome
• Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

Signs & Symptoms of Autism

Although people with autism often have no distinguishing characteristics in terms of appearance, they may communicate, engage, conduct, and learn in unusual ways.

The following are some signs of autism spectrum disorder:³

• Difficulty developing social communication and interpersonal skills
  • Example – Does not respond to name by nine months of age
• Restricted or repetitive interests or behaviors
  • Example – Becomes upset by minor changes in routine
• Delayed cognitive, learning, language, and movement skills
• Hyperactive, impulsive, and/or inattentive
• Epilepsy or seizures
• Unusual sleeping and eating patterns
• Gastrointestinal issues (i.e., constipation)
• Mood swings or emotional reactions that are out of the ordinary
• Anxiety, tension, or excessive worry
• Fearlessness or greater than expected fear

Is Autism Testing Covered by United Healthcare?

United Healthcare may cover autism assessments depending on your insurance plan’s benefits.

Because there is no medical test for ASD, such as a blood test, diagnosing it can be challenging. To diagnose autism, autism doctors, nurses, and other specialists from the healthcare, community, or educational sectors perform developmental screening, which looks at the child’s developmental history and behavior. A comprehensive developmental evaluation can determine whether or not a person meets the criteria for an autism diagnosis. It can also help identify the best treatment options. Observation, standardized tests, interviews, and questionnaires are common components of this evaluation.

Autism can be recognized as early as 18 months of age. As a result, a trusted diagnosis by an experienced practitioner by the age of two is possible. Many, however, do not obtain a conclusive diagnosis until they are much older.⁴

Are Autism Treatments & Medications Covered by United Healthcare?

Yes, United Healthcare may cover autism treatments and medications. Your plan’s benefits will determine your eligibility and the details of your United Healthcare coverage for autism treatment and medication.

There is no specific medication for autism or any of its symptoms. However, some medications can help alleviate symptoms like depression, anxiety, hostility, repetitive behavior, hyperactivity, and concentration problems. For example, some antipsychotic drugs, such as risperidone and aripiprazole, have been approved by the FDA for treating irritability associated with autism in children of certain ages.⁵

According to research, medication is most beneficial when paired with evidence based psychotherapy, such as Applied Behavior Analysis (ABA). ABA applies what we know about behavior to real-life settings. The goal is to promote positive behaviors while minimizing negative or learning-inhibiting ones. Language and communication skills, attention, focus, social skills, memory, and academics can all benefit from this form of therapy.⁶

How To Find United Healthcare Autism Testing & Treatment Clinics Near Me?

With Athena Care, autism services are within reach. Open Monday through Friday, 7:00 a.m. to 6:00 p.m., Athena Care’s autism testing clinics in Tennessee provide superior care for many of your behavioral and mental health needs. A care coordinator can assist you with any questions or concerns about United Healthcare and autism at one of our multiple locations throughout Tennessee.

When choosing care providers, it’s important to ask many questions and keep the following in mind:

• Education, training, license, and years of experience
• Specialties and services offered
• Treatment methods and philosophies
• Insurance companies they work with
• Office hours
• Pricing
• Session length

Here, you’ll find a list of practitioners organized by city and information about their backgrounds and specialties.

How Much Does Autism Testing & Treatment Cost Without Insurance?

The following are average costs, though they may vary by location and other factors. Therefore, they may not reflect the actual cost you’ll pay for autism testing or treatment services in Tennessee.

Doctor’s visits alone can range from a few hundred dollars to more than $2,700. In the United States, the typical cost of psychotherapy ranges from $100 to $200⁷ a session, dependent upon the state and the length of the session.

The cost of a supply of 30 risperidone 1 mg oral tablets is roughly $18,⁸ and the average price of applied behavior analysis is $120 an hour. Some children require up to 40 hours of ABA therapy every week to reach their full potential, which amounts to $4,800 per week or $249,600 annually.⁹

Can Autism Affect My Insurance Coverage?

Most states, including Tennessee, require insurance companies to fund autism therapy.¹⁰ Opponents of this method contend that it is the role of parents and educational systems to care for children with autism. Others have expressed concerns that requiring autism coverage would drastically hike insurance prices.

According to the American Academy of Pediatrics, state insurance mandates were linked to a 16% increase in board-certified behavioral analysts. This argument has heated up, and states are attempting to satisfy the needs of children and adults with autism in numerous ways. For example, mandatory coverage may be restricted to certain age groups, a certain number of annual visits, an annual spending cap, or other restrictions.