How to Write Sleep Goals That Insurance Will Actually Approve (Maybe)

Let’s face it. Insurance companies can be, well... particular. And by “particular,” I mean that sometimes it feels like you could submit the most beautifully written, data-backed goal in existence, and it still gets kicked back with a note that says something like:

“Sleep isn’t medically necessary.”

Hmm.

While we can’t guarantee every goal will make it past the approval gatekeepers, we can stack the odds in our favor by following a few simple rules of thumb.

1️⃣ You Don’t Even Have to Say “Sleep”

While there are so many behavioral components to good sleep, sleep itself is not a behavior. It's a biological process. And that word alone is enough to make some insurance reviewers raise an eyebrow.

So instead of targeting “falling asleep,” focus on the behavioral pieces that get a child ready to sleep:

• Learning calming leisure skills (because jumping on the bed at 8:45pm is not it)

• Following a bedtime routine using a visual schedule

• Relinquishing screens or preferred items without meltdowns

All behavioral. All defensible. All insurance-friendly. ✅

Example Goal: Learner will independently follow a visual schedule of routine activities on 80% of opportunities across 4 consecutive weeks, in the absence of interfering behaviors

2️⃣ Connect the Daytime Dots

Many of the kids who struggle at bedtime are the same ones who struggle with interfering behaviors during the day.

If a learner can’t leave the playground without a full-blown tantrum, we probably shouldn’t expect a peaceful transition to bedtime either.

Instead of targeting the nighttime behavior directly, look for daytime contexts where similar behaviors pop up and write goals around:

• Tolerating transitions

• Accepting “no”

• Delaying reinforcement

It’s all connected — and it’s all perfectly within our scope.

Example Goal:  When told that tablet time is all done, Learner will put the tablet down and engage with an available alternative in the absence of dangerous interfering behaviors on 10 out of 10 opportunities per week across 4 consecutive weeks.

3️⃣ Lean Into Caregiver Goals

While a goal like “Child will wake up at 7am every day” will never make it past peer review, a goal like:

“Caregiver will implement consistent routines and reinforcement systems across home routines”…will likely fly right through.

It gives parents the tools to support consistency at bedtime, and wake-ups, without raising any insurance red flags.

Example Goal:  Caregivers will prompt Learner through a 10-minute routine consisting of calming leisure skills, and provide reinforcement for cooperative behaviors, on at least 1 opportunity per day across 2 consecutive weeks.

✨ Final Thoughts

We may never crack the full insurance approval code (if you do, please share your secrets), but we can absolutely write smart, ethical, and effective goals that support sleep — even if they don’t say “sleep.”

Because at the end of the day, helping our learners and families get better rest doesn’t just improve sleep… it improves everything.

Ready to get your learners on the path to better sleep and better sessions? Check out our step-by-step sleep guide designed for BCBAs, so you can:

✔️ Identify common sleep barriers and address them during the day

✔️ Teach families routines that actually stick

✔️ Reduce cancellations, crankiness, and mid-session naps

✔️ Share ready-to-use visuals and resources with parents

✔️ 1:1 Q+A session with me to ask your specific questions.

Send Me the Guide!