Insurance Q&A:

Deductibles? Co-Pays? Out of Pocket Maximum? Insurance can be confusing. 
Our Team is here to help you understand your ABA coverage and the process to claim benefits. You are not alone. Our Team is prepared to help our families navigate insurance coverage for Autism therapies. Please feel free to call our Patient Care Coordinator for assistance. 

 Step 1: Verify Benefits 

Our Team needs the following information:

  • copy of current insurance card
  • policy holder's first and last name
  • child's first and last name
  • child's date of birth
  • a current address
  • current phone number


Our Team will contact your insurance carrier to find out if you have coverage for ABA services. This process can take 1-2 days.  A Team Member will contact you with the answer.

Step 2: Authorize an Assessment

If you do have ABA benefits and you would like to use your insurance to pay for services, our Team needs to authorize an assessment. 
Our Team needs the following information:


  • Proof of Diagnosis*
  • Prescription for ABA services written AND signed by a Physician, Pediatrician, etc (anyone with a M.D. or PhD)

*The diagnosis letter should be dated 2015 or after with new coding (F84.xx instead of 299.xx).

Our Team will then call the insurance company back. The insurance company will give us permission to start an assessment with your child. We can not start services until we have an authorization.

3. The Assessment

You will need to schedule the Assessment with our office. The Assessment can take up to 10 hours. Assessment sessions are typically scheduled in 2 hour blocks. Your child will work 1:1 with a BCBA (Board Certified Behavior Analyst) until the Assessment is complete.

4. Authorize On-Going Services

 When the Assessment is complete, a BCBA will schedule a time to meet with you to review your child's assessment and discuss your child's treatment plan. The Team will recommend the number of hours we think will benefit your child the most.  Our Team will submit the Assessment to your insurance company along with a request for on-going services. Once we have received an authorization, we will begin services.  Your child will work 1:1 with a Line Therapist.  Your child will receive supervision of their program by a BCBA.

5. 6 Months Later...

Every 6 months, insurance companies require an updated Assessment. 
Our Team needs the following information:


  • NEW prescription for ABA services written AND signed by a Physician, Pediatrician, etc (anyone with a M.D. or PhD)

Our Team does NOT need a new Proof of Diagnosis.  Our Team will then call the insurance company back. The insurance company will give us permission to start an assessment with your child. We can not start services until we have an authorization.  You will need to schedule the Assessment with our Patient Care Coordinator. The Assessment can take up to 10 hours.Sessions are typically scheduled in 2 hour blocks.  Your child will work 1:1 with a BCBA (Board Certified Behavior Analyst) until the Assessment is complete.

FAQ

Question: How much will I owe after insurance?

Answer: It depends. Every plan is different. Our Patient Care Coordinator will provide the

specifics of your individual plan after benefits have been verified. 

Things to remember:

  • You might have to pay the whole bill for the first few months until you reach your deductible.
  • You might have to pay co-insurance until you reach your out-of-pocket maximum. 
  • You might have to pay a co-payment. 


Question: What if Brightwork ABA Therapy is not an in-network provider with my insurance carrier?
Answer: Our Team will go through the same process to verify benefits.

We will then try to negotiate a single case agreement. 


Question: What if I do not have ABA coverage through my insurance?

Answer: We offer a private pay option. We strive to offer competitively priced, high quality services to anyone who wishes to receive therapy through our agency.  However, you may also be eligible for services through a regional center.  Please call for details and we can help guide you.

 

 




 

 

*Thanks to Appleseeds Learning Center for this Q&A!

Brightwork ABA Therapy

 



Call Us:  +1.3105261099