ABA Reimbursement

In May of 2019, Anthem announced that they would be cutting ABA reimbursement rates by 35% on July 1, 2019. This cut caught many ABA providers and families off guard. On July 1, 2019, these cuts went into effect. The magnitude of this cut had the potential to be crippling for ABA providers and to diminish the quality of ABA services for many individuals with autism in Indiana that rely on these services.

The news of this cut resulted in an outcry from many concerned parents of children with autism as well as from advocacy groups such as the Autism Society of Indiana (ASI). On September 3, 2019, Anthem informed providers that they would reinstate the fees for the two ABA CPT codes that decreased on July 1, 2019. Anthem also stated that they would re-process any claims previously reimbursed at the July 1 reduced rates.

Anthem informed providers on September 3, 2019, that one of the two codes being reinstated would be cut on December 1, 2019, by 18%. This code (97153) is for Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified health care professional, face-to-face with one patient. Given that up to 80% of an individual’s time in ABA therapy is spent with a Registered Behavioral Technician (RBT) this cut is an 18% cut in reimbursement for the majority of services a child with autism receives in ABA centers.

ASI believes that this cut is unacceptable. This cut is unwarranted, has the potential to set a precedent for other insurance providers and will significantly impair the quality of therapy an ABA center is able to provide. ASI is calling on Anthem to reconsider this cut and to consider the ramifications this cut will have on individuals with autism in Indiana who need ABA therapy.

Parents and providers, many of us were caught off guard on July 1, 2019, by Anthem’s initial cut, let’s not be caught off guard by Anthem’s proposed cut on December 1, 2019. ASI encourages you to speak out against this unfair and unethical cut. Please share your stories about the positive impacts ABA therapy has had on your child with autism.

Below is a list of action steps/individuals and organizations you can contact directly to express your frustration:

  • Contact your HR department at work as they work on healthcare coverage plans and ask them to reach out to Anthem to express concern over the rate cuts.
  • Reach out to your various State Legislators.
  • Contact Governor Eric Holcomb via email, by phone at 317-232-4567 or on social media at @GovHolcomb.
  • Contact Lt. Governor Suzanne Crouch via email, by phone at 317-232-4545 or on social media at @LGSuzanneCrouch.
  • File a complaint with the Department against Anthem specific to the rate cuts.
  • Contact Anthem, directly voice your concern by calling Anthem at 800-331-1476

Download ASI Statement on Anthem ABA Reimbursement Rates

ASI Statement in September 2019 –  Download ASI Statement for Anthem Cuts 2019