What I Wish I Knew Before Saying Yes to the First Referral
Our two kids spent years in ABA because that is what our pediatrician and our insurer made simple. The script was familiar: autism diagnosis, immediate ABA referral, instant authorization for dozens of hours. OT and ST were presented as afterthoughts with long waitlists (unless you go the private pay route), caps, and copays. We assumed the path was evidence based. It was actually insurance based.
In ABA, our children practiced compliance, not connection. Meltdowns became longer, not fewer. The triggers were sensory and communication, yet plans focused on extinguishing behaviors. When we finally prioritized OT and ST, everything shifted. An OT helped us map sensory needs and daily routines. A speech therapist gave us language supports and AAC options. Our home felt calmer within weeks.
Hard truth: insurers tend to fund what is predictable and billable at scale, not what is individualized and interdisciplinary.
Here is how the system quietly nudges families:
- ABA is prepackaged. Big blocks of hours, one vendor, one authorization. It looks efficient to an insurer.
- OT and ST are fragmented. Separate referrals, fewer covered sessions, “progress” reviews that create denials and gaps in care.
- Medical necessity is framed narrowly. Behavior charts are accepted as proof. Sensory regulation, feeding, motor planning, and functional communication are treated like extras instead of essentials.
What finally worked for us: We asked our doctor to write specific, functional goals for OT and ST. We submitted letters of medical necessity for safety, feeding, daily living, and school access. We appealed denials and requested concurrent authorizations. Most importantly, we tracked outcomes. When ABA data showed “skills mastered” but our child still could not tolerate the grocery store or ask for help, we stopped. When OT and ST goals reduced distress and improved independence, we doubled down.
One medical fact: Sensory processing differences are commonly reported in autistic children, and occupational therapy directly targets sensory regulation and daily function (Journal of Autism and Developmental Disorders).
Someone that did a 3 month crash course to become an ABA technician does not have the same skill set as someone who spent years of studying and multiple lengthy fieldwork experiences.
If you are at the starting line, learn from our detour. Follow your child, not the coverage grid. Ask for OT and ST evaluations on day one. Demand that authorizations reflect your child’s real needs. ABA may be easy to approve, but easy for insurance is not the same as right for your family.
