Short answer: Magellan Health manages behavioral health benefits, including applied behavior analysis, on behalf of many health plans and employers. If Magellan appears on your insurance card for behavioral or mental health, it is usually the company that reviews and authorizes ABA for your child. Whether ABA is covered depends on how your plan is written.
Effective Family Support accepts Magellan Health. We verify your benefits before your child starts, so you know the cost up front.
The Magellan-Specific Thing to Check First
Magellan is often a behavioral health manager rather than your main insurance company. Your medical coverage may come from one company while Magellan handles behavioral health services like ABA. Check the back of your insurance card for a separate behavioral health phone number, and call that number when you ask about ABA. It is also worth confirming whether your plan is fully insured or self-funded through an employer, which determines whether the Florida mandate below applies.
Please note that Effective Family Support does not accept Medicaid, including Medicaid plans managed by Magellan.
What Florida Law Requires
Two Florida statutes mandate coverage for applied behavior analysis. Section 627.6686 applies to fully insured large group plans and the state employee group health program; section 641.31098 applies to large group HMO plans. Under these sections, an eligible individual is someone under 18, or 18 and older but still in high school, who was diagnosed with a developmental disability at age 8 or younger.
Where the mandate applies, coverage is capped at $36,000 per year and $200,000 in total lifetime benefits, treatment must be prescribed by the treating physician under a treatment plan, and coverage cannot be denied simply because the services are habilitative rather than rehabilitative.
The mandate does not reach every plan. Individual market plans, individually underwritten plans, and small employer plans fall outside these sections. Self-funded employer plans are governed by federal law rather than Florida law. Many of those plans still cover ABA, but they are not required to by these statutes.
What to Have Ready When You Call
- Your member ID and the subscriber’s date of birth
- Your child’s date of birth and autism diagnosis
- The behavioral health phone number from the back of your card
- Whether the plan is fully insured or self-funded through an employer
Questions worth asking on that call: Is applied behavior analysis a covered benefit? Is prior authorization required, and what documentation is needed? What is my deductible, coinsurance or copay for these services? Is there an annual visit or dollar limit? Is Effective Family Support in network?
Common Questions
Do I need a formal autism diagnosis first?
Yes, in almost all cases. Insurers require a diagnosis to establish medical necessity for ABA. If you do not have one yet, we can point you toward next steps.
Does Magellan require prior authorization?
Magellan typically reviews ABA through prior authorization, and the documentation usually includes an assessment and a written treatment plan from a Board Certified Behavior Analyst. We handle that submission as part of getting started.
What if my plan does not cover it?
Tell us and we will talk through the options honestly, including private pay and, for some Florida families, scholarship programs. We would rather give you a straight answer than sign you up for something you cannot sustain.
How quickly can we find out?
Send us your plan details through our contact form, or complete our intake form, and we will start the verification. You will get a written estimate before anything begins.
How We Handle It
You do not have to do this alone. Give us your plan information and we will verify your benefits directly, confirm what prior authorization is needed, and give you a clear written estimate of any out-of-pocket cost before your child’s first session. No surprises after you have already started.
We provide ABA therapy in your home, at your child’s school, and in community settings across Miami-Dade, Broward and Palm Beach County, for children ages 2 through 6.
This page is general information, not a coverage determination. Your plan documents and your insurer control what is covered in your specific case.