A referral is usually required by insurance to open the door.

It typically comes from:

• A pediatrician

• A developmental pediatrician

• A neurologist

• A psychologist or qualified diagnosing provider

The referral confirms:

• The child is being referred for ABA therapy

• The diagnosis or suspected diagnosis

• That ABA is medically appropriate to pursue

Some plans waive referrals—but many do not, especially HMOs.

2. Letter of Medical Necessity (LMN)

This is one of the most important documents—and one of the most misunderstood.

A Letter of Medical Necessity explains:

• Why ABA therapy is needed

• How the child’s diagnosis impacts daily functioning

• Why ABA is medically necessary (not optional or educational)

• The expected benefit of treatment

It is usually written by:

• The diagnosing provider

• A physician

• Sometimes the ABA provider’s clinical director (depending on insurance rules)

No LMN = weak or denied authorization.

3. Comprehensive Diagnostic Evaluation (CDE)

This is the foundation.

A CDE:

• Confirms a formal diagnosis (such as Autism Spectrum Disorder)

• Includes clinical observations and standardized testing

• Is required by most insurers to approve ABA

• Must be recent and completed by a qualified, licensed provider

Without a valid CDE, many ABA companies cannot even submit an authorization request.

Simple—but critical.

The ABA provider needs:

• Front and back of the insurance card

• Correct member ID and group number

• Accurate policyholder information

Errors here cause:

• Eligibility issues

• Delayed benefits checks

• Denials before the process even starts

Always double-check this step.

To start ABA therapy smoothly, you almost always need:

• a Referral

• Letter of Medical Necessity

• Comprehensive diagnostic Evaluation (CDE)

• Insurance Card