Priority Partners ABA Therapy Coverage in Maryland

Insurance should never be a barrier. That’s why Wonder Star ABA partners with Priority Partners to make accessing exceptional therapy as simple as possible.
 
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What Wonder Star ABA Does with Your Priority Partners Plan

Benefits Verification

We contact Priority Partners directly to confirm your coverage details—what's included, what you'll pay, and how many hours are approved.

Authorization Management

We prepare and submit all prior authorization requests with the clinical documentation Priority Partners requires, then follow up until approval comes through.

Claims Processing

We handle every claim submission, track payments from Priority Partners, and resolve any billing issues that come up.

Ongoing Communication

You'll always know where things stand with Priority Partners—coverage status, authorization renewals, and any changes to your benefits.

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ABA Services Covered by Priority Partners

Direct Therapy in Your Home

One-on-one sessions with a trained RBT. Your child learns communication skills during real conversations, practices managing emotions during actual transitions, and builds independence in the place they spend most of their time.

School Support Services

ABA therapy at school—in the classroom, cafeteria, playground. We help your child succeed during group activities, handle frustration when work gets challenging, and navigate social situations with classmates.

Family Training Sessions

You learn the same techniques our therapists use. We show you how to support skill development during meals, bedtime, outings—and how to maintain progress after formal therapy ends.

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What You Should Know About Priority Partners ABA Coverage

Maryland Medicaid Managed Care Plan

Priority Partners is a Medicaid managed care organization operated by Johns Hopkins HealthCare LLC, serving families across Maryland with comprehensive behavioral health benefits for children with autism.

No Annual Cap for Children Under 21

Priority Partners works through Carelon Behavioral Health Maryland to administer the ABA therapy program. Authorization requests are processed through Carelon for clinical and operational oversight.

Standardized Assessment Requirements

Priority Partners covers ABA therapy with no annual dollar limit for children under 21 as long as services remain medically necessary. This coverage is provided through Maryland's Medicaid EPSDT benefit under HealthChoice.

Progress Reviews Every 6 Months

Priority Partners requires a formal autism spectrum disorder (ASD) diagnosis from a qualified healthcare provider and an approved comprehensive treatment plan outlining therapy goals, objectives, and duration before services can begin.

Prior Authorization Required

Prior authorization is required before ABA therapy can begin. Carelon reviews diagnostic documentation, treatment plans, and medical necessity before approving services. Multiple steps may be involved, so working with experienced providers streamlines the process.

Reauthorization Every 6 Months

Authorization is typically granted in 6-month increments. Priority Partners/Carelon reviews progress data at reauthorization and may adjust hours based on documented outcomes.

No Out-of-Pocket Costs

As a Medicaid plan, Priority Partners members pay zero copays and zero deductibles for ABA therapy services.

Authorization Timeline

Initial authorization typically takes 10-14 business days once all required documentation is submitted through Carelon. We handle all paperwork and coordination.

Getting Started Is Simple

Get Started Now

1. Reach Out to Us

Call or submit our contact form. Have your Priority Partners member ID and your child’s autism diagnosis ready.
 

2. We Verify Coverage

We contact Priority Partners to confirm your benefits and get answers about coverage details.
 

3. Authorization Gets Submitted

We prepare the clinical documentation Priority Partners needs and submit the authorization request. Then we follow up with them until it’s processed.
 

4. Therapy Begins

Once Priority Partners approves, we schedule your child’s first session—at home or school, based on what works for your family.

 

 
 

Making Your Priority Partners Benefits Work for You

Getting Ready

  • Have your Priority Partners card handy—both sides
  • Gather your child’s diagnosis documentation
  • Ask us about any extra paperwork your plan requires

During Treatment

  • We track your authorization timeline with Priority Partners
  • We submit renewal requests before your current approval expires
  • We keep you updated on your coverage and any Priority Partners correspondence

If Coverage Issues Come Up

  • We appeal denials with additional clinical support from our BCBAs
  • We explore payment options for any out-of-pocket expenses
  • Most families find solutions that work—accessing services is rarely impossible
Questions? Contact Us

What Makes Wonder Star ABA Different

Experience with Priority Partners

We’ve worked with Priority Partners on hundreds of cases. We know their processes, their documentation standards, and how to navigate their system effectively.

End-to-End Support

From your first call through final claims, we manage everything Priority Partners-related. You won’t need to learn insurance jargon or billing procedures.

Clear Cost Information

Before therapy starts, you’ll know exactly what Priority Partners covers and what you’re responsible for. No surprise bills months down the line.

Real-World Therapy Settings

Sessions happen where your child actually needs the skills—at home during daily routines, at school during real academic and social challenges.

Honest Communication

When Priority Partners denies something, we explain what’s really happening (not just what their form letter says) and how we’ll address it.
About Our Approach

Common Questions About Priority Partners Coverage

How much will I pay with my Priority Partners plan?
It varies by plan. Some families only pay their premium. Others have copays (usually $10-50 per session), deductibles, or coinsurance. We’ll verify your specific costs before starting.
Depends on your Aetna Better Health plan. We’ll check your requirements and help coordinate any needed referrals.
Usually an autism diagnosis, a BCBA treatment plan, and prior authorization paperwork. Sometimes they request additional medical or educational records. We handle all of it.
Typically 7-14 business days. Sometimes faster if everything’s complete. Sometimes longer if they need more documentation. We stay on top of it and keep you informed.
Most Maryland Aetna Better Health plans authorize 10-40 hours weekly based on clinical need and plan limits. We request what your child needs and appeal if they approve less.
We appeal with stronger clinical documentation from our BCBAs and your medical team. Most denials get overturned with the right information.
Yes. ABA therapy is a qualified medical expense, so you can use Aetna Better Health HSA or FSA funds for copays, deductibles, and out-of-pocket costs.
We work with most major insurers in Maryland. If you have different coverage, we likely accept it. We also offer self-pay options if needed.
Some plans extend coverage to ADHD or developmental delays. Many don’t. We’ll verify what your specific plan covers.
Aetna Better Health typically covers ABA as long as it’s medically necessary. We monitor your benefits and keep you informed throughout treatment.
We work with Aetna Better Health across Maryland. During verification, we’ll confirm in-network status with your specific plan—which usually means lower costs.
Aetna Better Health typically authorizes therapy in 3-6 month blocks. We track expiration dates and submit renewals 30 days early to avoid gaps.
More Questions? Ask Us

Ready to Move Forward?

We’ve helped hundreds of Maryland families navigate Priority Partners coverage. We know how to get approvals, handle denials, and keep therapy moving forward.

Let’s get your child the support they need.

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