Insurance & cost
How insurance works for ABA, speech, OT and mental health in California
Insurance is the number one question parents ask us, and for good reason. Here’s a plain-English overview of how coverage usually works in California for ABA, speech and occupational therapy.
Commercial insurance (through an employer or Covered California)
- ABA / behavioral health treatment: California law requires state-regulated plans to cover medically necessary behavioral health treatment for autism. Most plans need a diagnosis report and prior authorization.
- Speech and occupational therapy: usually covered when medically necessary, sometimes with visit limits or a referral from your pediatrician.
- Mental health therapy: California’s mental health parity law requires coverage on terms comparable to medical care.
Medi-Cal
Medi-Cal covers medically necessary services for members under 21, including behavioral health treatment, speech and occupational therapy. Services are typically arranged through your Medi-Cal managed care plan.
Does the Village accept Medi-Cal? Call us and we’ll tell you which Medi-Cal plans and services we currently accept. To confirm Placeholder: list the accepted plans and services here.
Regional centers
Regional centers (Alta California Regional Center for El Dorado County) can fund some services for eligible children, especially under age 3 through Early Start, and may help when insurance doesn’t cover something.
Questions to ask your insurer
- Is this service covered for my child’s diagnosis?
- Do I need prior authorization or a referral?
- Is It Takes THE VILLAGE in-network for this service?
- What’s my deductible, and how much of it have I met?
- What is my copay or coinsurance per visit?
No coverage? You still have options
We offer private pay and can provide a superbill (a detailed receipt) you can submit for possible out-of-network reimbursement. Our team is happy to walk you through it. Just request an appointment and mention insurance questions.
Mental health coverage
Counseling and family therapy are usually covered as outpatient mental health visits, billed per session with a copay or coinsurance. California and federal parity rules mean your plan cannot set stricter limits on mental health care than on other medical care.
Three things to check before the first visit: whether your clinician is in network, whether your plan needs a prior authorization for therapy, and how many visits are covered per year. Our team can check all three with you.
Have a question about your child?
Our team can help you figure out a good first step, including insurance.