Appealing an ABA denial from Union County, and the deadline people miss

Step-by-step guide to appealing an ABA therapy denial in Union County, NJ. Includes the most missed deadline and key contacts.

Published September 1, 2026 · Union County, New Jersey

Why denials happen and what you can do

If you live in Union County and your child’s ABA therapy was denied by your insurance plan, you are not alone. Denials happen for many reasons: missing documentation, a diagnosis code that does not match, or the insurer deciding the therapy is not “medically necessary.” The good news is that you have the right to appeal. The bad news is that many families miss the first deadline because they do not realize it exists.

The deadline most people miss: the internal appeal window

When your insurance company sends you a denial letter, it will include a deadline for filing a “first-level internal appeal.” That deadline is typically 180 days from the date you receive the letter. But the mistake families make is waiting too long to gather records, or assuming they can appeal later. In New Jersey, if you miss that 180-day window, you lose your right to an internal appeal. You may still have external review options, but the process becomes harder. Mark your calendar the day the letter arrives.

Step 1: Read the denial letter carefully

The denial letter must say why the claim was denied and tell you which specific policy or guideline was used. It will also list the deadline for appeal. Look for phrases like “not medically necessary,” “experimental,” or “out of network.” Keep a copy of every letter. If you do not understand the reason, call the customer service number on your insurance card and ask for a clear explanation. Write down the date, time, and name of the person you speak with.

Step 2: Gather your child’s records

You will need a letter from your child’s doctor or a qualified behavior analyst that explains why ABA is medically necessary. Include any diagnostic reports, treatment plans, and progress notes. If your child is under 3, contact the New Jersey Early Intervention System for records. If your child is 3 or older, ask PerformCare (the single access point for the Children’s System of Care in New Jersey) for any assessments they have. For children under 21, your managed care plan (Horizon NJ Health, Wellpoint, Aetna Better Health of NJ, or UnitedHealthcare Community Plan) is the one you appeal to. After age 21, the Division of Developmental Disabilities handles services.

Step 3: File the internal appeal

Send your appeal in writing. Use certified mail or a service that gives you a delivery receipt. Include your child’s name, date of birth, insurance ID number, the denial date, and a copy of the denial letter. Attach all supporting records. Write a short cover letter that says: “I am appealing the denial of ABA therapy for my child. Please treat this as a first-level internal appeal.” Keep a copy of everything you send. The insurance company must respond within 30 days (or 15 days if the denial was for urgent care). If they do not respond, you can move to the next step.

Step 4: If the internal appeal is denied, request an external review

If the insurance company upholds the denial, you can ask for an external review by an independent organization. In New Jersey, this is handled by the state Department of Banking and Insurance. You must file the external review request within four months of the internal appeal denial. The external reviewer is not employed by your insurance company. Their decision is binding. You can also ask for an expedited review if your child’s health is at risk.

Who to call for help in Union County

You do not have to do this alone. Start with your child’s pediatrician or the ABA provider who recommended therapy. They have experience with denials. If your child is on NJ FamilyCare (New Jersey’s Medicaid and CHIP program), you can also call PerformCare at their published number for help with the appeals process. For children under 3, the New Jersey Early Intervention System can provide guidance. For older children, your school district (for example, Berkeley Heights School District, Clark Township Public School District, or Elizabeth Public Schools) may have a special education parent liaison who can help you understand your rights under IDEA if ABA is part of an IEP.

What if you cannot afford a lawyer?

You do not need a lawyer to file an appeal, but if you want one, look for pro bono or low-cost legal help. Disability Rights New Jersey offers free legal services for people with disabilities. You can also contact the New Jersey State Bar Association for a referral. If you are low income, legal aid clinics in Union County may help.

A note on uncertainty

Every insurance plan is different, and every denial letter is different. The exact deadlines and forms can vary. If you are unsure, call the insurance company and ask: “What is the exact deadline for my first-level internal appeal?” Write down the answer. If you still are not sure, call the New Jersey Department of Banking and Insurance for guidance. They regulate insurance companies in the state.

Remember: you are not alone

Union County has 52 registered ABA providers and every town has a provider within 7 miles. That means there are professionals nearby who have seen denials before. Ask your provider’s billing office for help. Many will write an appeal letter for you. The most important thing is to act quickly. Do not wait. The deadline you miss is the one you ignore.