Autism diagnoses among children and adults in the United States have increased by 175% in the last decade, creating an urgent and growing demand for support services. Unfortunately, the cost of applied behavioral analysis (ABA) services can be significant — in some cases, totaling between $40,000 to $60,000 per child per year.
As ABA therapy costs continue to climb, employers are in a unique position to bridge this gap by enhancing benefit plans and creating an inclusive workplace that understands the needs of neurodivergent workers and/or children who may be covered through their parents’ insurance offerings.
In this guide, we’ll provide some strategies for doing so — and explain how Vālenz Health® can support both employers and plan members in accessing high-quality, low-cost ABA therapy services through an industry-leading approach to claims repricing.
ABA therapy is an evidence-based treatment focused on encouraging positive behaviors instead of punishing undesirable behaviors. By changing the focus from punishment to reward, board-certified behavior analysts reinforce behaviors that help people with autism develop social, communication, and learning skills that improve their quality of life.
However, ABA therapy also presents a financial hurdle that can cost families hundreds of dollars per week.
Insurance is essential to lowering these costs, but plans vary widely. Some plans offer limited coverage, while others offer comprehensive support. Employees and their families often face high out-of-pocket expenses, session caps, prior authorization, and a requirement to obtain a formal diagnosis from a qualified healthcare professional.
Navigating these challenges and high costs can be difficult for many employees, who are often left to look for other options, such as financial assistance programs, state-funded programs, and nonprofit resources. This makes it crucial for employers to review and enhance their benefit offerings to ensure employees receive the support they need.
Reducing the cost of ABA therapy doesn’t have to mean cutting corners. By taking strategic, intentional steps to improve access, coverage, and support, employers can ease the financial burden on families while strengthening their overall benefits offering.
Make it easier for employees to access and afford ABA therapy by building meaningful support into your benefits plan.
For example, offering health plans that cover ABA therapy can significantly reduce costs and ensure employees and/or their children receive the treatment they need at a cost they can afford. You can also partner with in-network providers to reduce out-of-pocket expenses. Lastly, consider providing flexible spending accounts and health savings accounts to help alleviate additional expenses.
Covering your employees isn’t enough when a child needs care. For many families, it can be financially out of reach to add dependents to a plan, especially when ongoing therapy is involved. Structuring your benefits to keep family coverage affordable is an important step in supporting working parents.
The high costs of ABA therapy can be mitigated with strategic payment integrity initiatives, such as repricing strategies designed specifically for these services.
As part of the Valenz Out-of-Network Repricing solution, our Payment Integrity team frequently leverages the ABA Repricing feature on behalf of our employer clients. Through an efficient, easily implemented repricing program (informed by the industry-leading Valenz Market-Sensitive [VMS®] Repricing methodology), our team delivers predictable vendor fees that minimize out-of-network spend on ABA therapy — for an average savings of 85%.
Employers that invest in strategic repricing services like these not only minimize overall plan spend; they also reduce the likelihood of out-of-pocket costs for employees, making ABA therapy more affordable for the populations that need it most.
Learn more about how our Payment Integrity solutions support employers like you by contacting our team today.
Navigating insurance, finding in-network providers, and understanding coverage can quickly become overwhelming, especially for families seeking ABA therapy. This is why healthcare navigation tools are especially helpful.
With solutions such as Valenz Precision Care Navigation, employees don’t need to figure it out on their own. Our navigation solution suite offers one-on-one guidance to help members:
These services can be enhanced with Valenz Bluebook’s cost and quality solution, which enables members to search for a procedure, physician, or facility to quickly find high-value care. This easy-to-use solution clearly displays provider costs in a green-yellow-red format, with green providers in the top third of cost and quality ratings.
With this transparency platform, members have the tools they need to reduce their out-of-pocket costs — and, more importantly, select providers who are proven to deliver higher-quality care that results in better health outcomes over time.
Learn more about the Valenz Bluebook tool today.
Flexible work arrangements are a crucial support system for employees managing healthcare challenges such as autism or caring for children with autism. Offering flexible hours or remote work options enables employees to schedule ABA therapy appointments without losing income or falling behind at work.
Even small changes, such as allowing for adjusted schedules or providing paid time off for healthcare visits, can make a significant difference. Flexible work gives employees space to focus on what matters most without the added stress of lost wages. In turn, it builds trust, improves morale, and supports long-term retention of valued team members.
Healthcare shouldn’t be harder — or more expensive — than it needs to be.
With a single platform and a dedicated team of experts, Valenz simplifies the process while uncovering new ways to save. Through robust specialty claims solutions such as complex clinical claim review — including for ABA therapy — Valenz helps employers ensure every claim is accurate, necessary, and aligned with contract terms.
At the same time, our comprehensive Member Experience suite — including the Valenz Bluebook platform — empowers employees to select high-quality, low-cost care through price and quality transparency and guided care navigation.
The result: Greater transparency, less waste, and meaningful cost savings for everyone.
Learn more about how you can reduce costs and steer employees toward high-value care for ABA therapy and other medical procedures by contacting a Valenz team member below.