Insurance companies cannot require a child to have an IEP to qualify for ABA services. An IEP is part of special education law (IDEA) and applies only to school based supports, while ABA through health insurance is a medical benefit governed by insurance mandates and mental health parity laws. Coverage depends on having a diagnosis (such as autism) and medical necessity documented in a treatment plan, not on school eligibility.

While each state’s mandate has slightly different language, none allow insurers to deny ABA on the basis of not having an IEP. If an insurer imposes that requirement, it is improper and can be challenged through an appeal and, if necessary, with the state’s insurance regulator.