Intake Process – Insurance

Please let us know you are interested in services by filling out an ABA Interest Form Here. Once the form is received our Program Director will contact you to let you know if we have a waiting list or to begin the insurance intake process.

1

ABA Benefits Verification

  • We will call your insurance company and verify that your plan includes coverage for ABA therapy.
  • We will get information regarding your estimated out-of-pocket costs (copays, deductibles, plan maximums)
  • This process can take 3-5 business days. We will contact you with the information as soon as possible.
2

Assessment Authorization

(This step can be completed at the same time as Step 1 IF we have all required information from you. Please be sure to fill out the intake paperwork in its entirety and to get required supplemental paperwork from your child’s physician as early in the process as possible.)

  • We will call your insurance company and request authorization for an initial ABA therapy assessment.
  • Approval for an ABA assessment can take 5-7 business days. We will contact you with the assessment approval or denial form your insurance company.
  • We cannot schedule your first intake appointment until we have an authorization on file.
3

The Assessment

  • We will schedule an initial intake appointment with the BCBA consultant who will be leading your child’s therapy team.
  • We will schedule assessment appointments and complete the initial assessment. The assessment will be broken down into multiple visits (usually 1-3 hours each) if needed.  The assessment can take up to 8 hours although we try to do it as quickly as possible so that we can begin services.
  • When the assessment is complete, we will schedule an appointment to go over the results of the assessment and review the treatment plan recommendations
4

Therapy Authorization

  • We will submit the results of the assessment and our treatment plan to your insurance company.
  • It can take up to 15 business days for the insurance company to review the information and make a determination on services.
  • We will contact you with the approval or denial as soon as we hear back from your insurance company.
  • We cannot start ongoing therapy services until we have an authorization on file unless you are willing to private pay for services prior to the authorization start date.
5

Re-authorization

  • Most authorizations are approved for a period of 6 months although occasionally they are approved for up to 1 year depending on your insurance plan.
  • Approximately one month prior to the authorization’s expiration date your consultant will re-assess your child and update his or her treatment plan.
  • At this point we will also need a new prescription for ABA therapy from your child’s physician.
  • We will submit the updated treatment plan and prescription to your insurance company.
  • It can take up to 15 business days for the insurance company to review the information and make a determination on services.
  • We try to start this process early enough that we have a determination from the insurance company prior to the expiration of the current prior authorization. However, when the prior authorization expires, if we do not yet have a new authorization, we will need to suspend services until we receive an updated authorization.

NOTE: We are in-network providers with Aetna, Humana, Magellan, Tricare, and United Behavioral Health.  For other insurance companies, we will complete ABA Benefits Verification and then contact you regarding next step for out-of-network claim submission.