Insurance denied your child's ABA, OT, or speech? Here's how to appeal (and win)

A denial letter is not the final word. It's the start of a process most families never use. Fewer than 1% of denied claims get appealed, yet independent reviewers overturn a large share of behavioral-health denials. If your child's ABA, OT, or speech therapy was denied, here's the playbook.

1. Read the denial for the reason

Find the stated reason and the deadlines. Common reasons: "not medically necessary," "prior authorization expired," "out of network," or an hour cap. Each has a counter.

2. File the internal appeal

Write a medical-necessity appeal (use our free appeal letter template) and attach:

• A letter of medical necessity from the treating provider
• The diagnosis and evaluation
• The treatment plan with goals
• Any progress notes showing the therapy works

File before the deadline (often 60–180 days). Send it so you have proof of delivery.

3. If denied, demand an EXTERNAL review

This is the step that wins. An independent external review sends your case to a reviewer not employed by the insurer, and behavioral-health denials are overturned at high rates. Your denial letter must explain how to request it; if you can't find it, call and ask. HealthCare.gov explains your appeal rights.

4. Stack the other coverage

While you appeal, check whether Medicaid or Katie Beckett could cover the therapy as secondary insurance, and whether a state ESA can fund it. See your state's benefits page.

Appeals are tedious, but a year of ABA can be $40,000–$60,000+, so this is the highest-value paperwork you'll ever do. Stuck? Ask the community; someone has beaten your exact insurer before.