When you’re the parent of a child with autism, navigating insurance plans can feel overwhelming especially when it comes to finding the right coverage for ABA therapy. In New York, three major insurance providers families often ask about are Fidelis Care, Healthfirst, and UnitedHealthcare (UHC). Each plan has different rules, coverage options, and networks which can make a big difference in how soon and where your child can get services.
This guide breaks down the key differences between these providers and helps you understand what to look for when choosing a plan that truly supports your child’s autism therapy journey.
Why ABA Therapy Coverage Matters
Applied Behavior Analysis (ABA) is a proven, research-backed therapy that helps children with autism build communication, social, and daily living skills. But not all insurance plans cover ABA therapy the same way or at all.
That’s why it’s so important to understand your options upfront. Many families start therapy only to find out too late that their plan doesn’t cover what their child needs, or has a long waitlist. Our goal is to help you avoid that stress and get your child the support they deserve as early as possible.
Fidelis ABA Coverage in NY: What You Need to Know
Fidelis Care is a popular option in New York, especially under Medicaid plans. However, Fidelis does not currently cover ABA therapy through many of the local ABA providers, including us. This is due to network restrictions and credentialing issues that limit where you can go for services.
Families with Fidelis often face long waitlists or limited provider options, which can delay therapy during a critical window of development.
If you currently have Fidelis and are struggling to access ABA therapy, consider reaching out to your plan or caseworker to ask about upgrading to a plan with wider behavioral health coverage like UHC or a commercial plan that includes ABA.
Read More: Does Medicaid Cover ABA Therapy in New York?
Healthfirst vs. UHC for Autism Services
Both Healthfirst and UnitedHealthcare (UHC) are widely accepted in New York, but they’re not the same when it comes to autism therapy coverage.
Healthfirst:
- Often used through Medicaid-managed care
- May offer limited ABA provider options
- Families often encounter long waitlists due to network restrictions
- Some plans may not cover full ABA services, especially for older children
UnitedHealthcare (UHC):
- One of the most ABA-friendly plans in New York
- Widely accepted by ABA providers, including ours
- Faster access to evaluations and therapy
- Offers broader coverage, including in-home and center-based services
If you’re comparing Healthfirst vs. UnitedHealthcare (UHC) autism coverage, UHC often provides faster, more flexible, and more comprehensive support for families starting ABA therapy.
Why We Don’t Accept Certain Insurance Plans (And What to Do Instead)
At our practice, we prioritize offering high-quality, timely ABA therapy that truly benefits your child. Unfortunately, not all insurance plans allow us to do that.
We currently do not accept Fidelis or Healthfirst plans because they limit the care we can provide. These plans often come with low reimbursement rates, network restrictions, or delayed approval processes all of which impact your child’s therapy experience.
Instead, we recommend plans like UHC or Aetna that give families more flexibility, faster access, and better outcomes.
If you’re not sure what your plan covers, our team offers a free insurance benefits check before starting services. That way, you’ll know exactly what to expect with no surprises.
Read More: Anthem Blue Cross Blue Shield ABA Coverage for New York Families
How to Choose the Right Plan for Your Family
When looking for a plan that supports your child’s autism needs, here are a few things to consider:
- Does it cover ABA therapy specifically?
- Is it accepted by local ABA providers you trust?
- What’s the wait time to get started?
- Does it offer in-home and center-based options?
- What is the co-pay or out-of-pocket cost?
Choosing the right plan now can make a huge difference in your child’s progress and peace of mind for your family.
Final Thoughts
Every child with autism deserves timely, effective care and that starts with the right insurance plan. While Fidelis and Healthfirst may seem like convenient options, they often don’t provide the coverage or access your child needs to thrive. UnitedHealthcare (UHC), on the other hand, is one of the most ABA-friendly choices in New York.
If you’re unsure about your plan or want help reviewing your options, we’re here for you. Reach out today and let’s make sure your child is on the path to the support they need without the wait.
Department of Financial Services Announces 2024 Health Insurance Premium Rates, Saving New Yorkers $732 Million.
- As Health Care Costs Rapidly Rise, DFS Protects Consumers Against Significant Rate Increases.
- Individual Plan Rates Reduced by 44% from Insurers’ Requested Rates, Saving Consumers $126 Million.
- Small Group Rates Reduced by 52% from Insurers’ Requested Rates, Saving Small Businesses $606 Million. (Source: Department of Financial Services NY)
