When we switched to Aetna we were told that they have a two tier system. This may be oversimplified but basically it breaks down like this - if your child is low functioning, nonverbal and aggressive then they consider ABA to be a medically necessary behavior therapy. On the other hand, if your child has a higher functioning level they consider ABA to be an educational service and does not fall into the purview medical services.
There is also a PowerPoint at autism
Speaks explaining it and there are companies that pay for some coverage I looked at trying specifically for my husband and I to get a job with one of them nf then realized many cover only til age 6 and we are going on 5 already
Not necessarily true. It depends on how your insurance is funded. If it is self funded then there is a loop-hole where state mandates for coverage are void.
Also look at a website called the butterfly effect it is worthwhile to look at
Thr mental health component of thr insurance handles ABA therapies.