Clementine ABA is in-network with most major commercial health plans and state Medicaid programs. Our intake team verifies your benefits, files every claim, and handles every appeal - so the only paperwork in your house is your child’s progress notes.
Type your insurance carrier in the search box or filter by state to see if we are in-network with your plan. Don’t see your insurance? Most families whose plan isn’t listed still get full coverage - talk to us anyway.
Don't see your insurance here? Tell us — we add carriers monthly.
Try a different state, plan name, or carrier. Or tell us your plan and we'll check coverage manually.
For most families, the hardest part of starting ABA therapy is the insurance maze. Clementine’s intake team handles every step of it - from the first phone call to your insurer to the last appeal. Here is exactly what they do.
We call your insurer and confirm exactly what your plan covers - visit limits, copays, deductible status, in-network rates - before your first appointment.
We file every form your insurer requires before therapy can begin. We follow up. We re-submit when documentation gaps appear. You never see any of it.
Every session generates a claim. Our billing team files it correctly the first time, monitors processing, and reconciles payments. You only ever see your share.
When an insurer denies a claim or downgrades a level of care, our team writes the appeal letter, attaches the clinical documentation, and fights it through to resolution.
ABA therapy is a major financial commitment when paid out of pocket. The good news is that most families never pay anywhere close to the uninsured rate, because Applied Behavior Analysis is covered by most major health plans. Here is the real math.
These are the typical national ranges for self-pay ABA therapy. Why so wide? Hours of therapy vary dramatically - a focused program of 5-10 hours per week looks very different from a comprehensive program of 30+ hours.
Self-pay families typically work on a sliding scale, payment plans, or shorter focused programs. We will tell you what's possible during intake.
When ABA therapy is in-network, your insurer covers most of the cost. What's left for you is usually a copay or coinsurance per session - and your annual out-of-pocket maximum caps the total no matter how many hours your child receives.
Medicaid programs in every state we serve cover ABA therapy 100% for eligible families. Many commercial plans have no copay for ABA after your deductible is met.
Want to know exactly what your family would pay? It takes us one business day to find out.
Start a free benefits checkHealth insurance has its own dialect. Most parents trying to figure out ABA coverage have to look up the same eight terms over and over. Here they are, in actual English, with the version of each that matters for ABA therapy.
The amount you pay out of pocket before your insurance starts paying. Resets every plan year (often January 1).
If your deductible is $2,000, you pay the first $2,000 of ABA costs each year. After that, your insurer takes over (minus copays/coinsurance).
After your deductible is met, the percentage of remaining costs that you pay. The rest is your insurer's responsibility.
20% coinsurance means after the deductible, you pay $20 out of every $100 in ABA bills. Your insurer pays the other $80.
A flat fee you pay per session or visit, separate from the deductible. Often the simplest version of cost-sharing.
A $30 ABA copay means you pay $30 every session, every time - regardless of what your insurer reimburses our practice.
The most you'll pay in a year. Once you hit this cap, your insurer covers 100% of in-network costs for the rest of the plan year.
If your out-of-pocket max is $6,000 and you've already paid that this year, every additional ABA session is fully covered until your plan resets.
Approval your insurer requires before they'll pay for a service. We handle this for you - it's not paperwork you have to chase.
Before your child's first ABA session, our team submits the treatment plan to your insurer for prior auth. We follow up until it's approved.
Providers (like Clementine) who have a contract with your insurer. You pay less because we've agreed to discounted rates.
If Clementine is in-network with your plan, you pay your copay or coinsurance. If we're out-of-network, you may pay more - but often less than you'd think.
Providers without a direct contract with your insurer. Some plans still cover out-of-network ABA partially. Often worth verifying.
If your plan only has in-network coverage and we're out-of-network, we can sometimes arrange a single-case agreement to bring you in-network for ABA.
A custom contract between your insurer and a specific out-of-network provider, just for your child. This lets you access care that's otherwise unavailable.
If there are no in-network ABA providers near you, we can request a single-case agreement so your insurer treats us as in-network for your case.
If you want to verify ABA coverage on your own - or if you just want to know what we’re checking when we verify for you - these are the nine questions our intake team works through for every Clementine family. Tap each one as you go.
Pour a coffee. Have your insurance card handy. The whole call usually takes about twenty minutes.
Questions to ask your insurer
Read each one to the rep. Write down the answer. We do the same thing every time - but you can do it yourself if you prefer.
We'll verify all nine of these for free in about a business day and let you know if you are cover
Let us run the checkThe questions we hear most from families verifying coverage for the first time, comparing plans, or trying to understand a denial.
Most commercial health plans and every state Medicaid program we work with cover ABA therapy for children with an autism diagnosis. The exception is some older self-funded employer plans and a small number of plans that exclude developmental therapies. Our intake team will verify your specific plan in 1-3 business days at no cost.
Use the search tool above to see if we’re in-network in your state. If you don’t see your carrier, contact us anyway - many plans we’re not formally in-network with still cover ABA through single-case agreements or out-of-network benefits.
We help families navigate alternative paths: state Medicaid waivers, school-funded services, community grants, payment plans, or focused (rather than comprehensive) programs. Cost should be a conversation, not a wall.
Yes - Clementine is enrolled with every state Medicaid program in the states we serve. Medicaid covers ABA therapy for eligible children with autism, typically with no out-of-pocket cost.
Yes. Medicaid managed-care plans are covered the same as traditional state Medicaid. Use the carrier search above to confirm your specific plan name.
Yes. Clementine is in-network with HealthyBlue and provides ABA therapy services
Most state CHIP programs (Children’s Health Insurance Program) cover ABA therapy for children with autism. We’ll verify your specific program’s benefits during intake.
Only for the portion your insurer assigns to you - typically a copay or coinsurance per session. We bill your insurer first, wait for their payment, and only then send you a statement (if there’s anything you owe). No surprise bills.
You’ll pay full session rates until you meet your deductible, then your insurance starts paying. We give you a clear projection during benefits verification so you know what to expect month-by-month. Many families combine ABA payments with HSA/FSA funds to manage the deductible phase.
Our billing team handles every appeal. We write the appeal letter, attach the clinical documentation, and follow up until resolution. You never have to call your insurer about a denied claim.
1 to 3 business days from when you share your insurance card. You’ll receive a summary of your benefits before any therapy is scheduled.
Tell us the day you find out, and we’ll re-verify benefits, transfer authorization to the new plan, and adjust scheduling if needed. Most insurance changes don’t pause therapy if we move quickly.
Your annual deductible resets (usually January 1). We let you know in advance what to expect in January and help you plan around it. Many families use HSA/FSA funds to offset the deductible reset month.
Have a specific question about your plan?
Our intake team verifies dozens of plans each week. Any specific question about coverage, billing, or appeals - we've probably answered it before.
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