Let us help you through the process!
Would you like us to check coverage on your behalf? We are happy to help! We can request benefit information on your behalf and contact you to discuss the information your carrier provides.
In June of 2007, the state of Texas passed the Texas Autism Insurance Law (HB 1919) requiring all fully insured group plans to provide coverage for autism services. Today, 46 states have enacted autism insurance reform policies nationwide. Unfortunately, Medicaid/CHIP does not cover ABA at this time. The following autism services are required to be covered:
- Evaluation and assessment services
- Applied Behavior Analysis (ABA)
- Behavior training and behavior management
- Speech therapy, occupational therapy and physical therapy
- Medications or nutritional supplements
Dealing with insurance can be complicated and intimidating. Our Admissions Specialists know exactly how to get you answer quickly. To begin this process, fill out the enrollment form and you will be given an opportunity to upload a digital copy of the following:
Please provide a photo or scan of the front and back of ALL insurance cards for your child regardless of coverage for therapy. Even if one of your policies does not cover ABA, Speech, or Occupational Therapy services, please include it with your application for accurate billing.
At this time, the only diagnosis recognized for the coverage of ABA therapy is, Autism Spectrum Disorder F84.0.
To obtain authorization for services, we will need you to provide a formal diagnosis report from a physician, psychologist, or psychiatrist using one of these assessment tools:
- Autism Behavior Checklist (ABC)
- Autism Diagnostic Observation Schedule(ADOS-2)
- Autism Diagnostic Interview (ADI)
- Childhood Autism Rating Scale (CARS)
- Checklist for Autism in Toddlers (M-CHAT)
- Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist (CSBS-DP-IT)
The diagnosis report also needs the following information discussed and assessed :
- Autism symptoms to include social relatedness
- Core ASD symptoms Repetitive or unusual behaviors
- Diagnosis of autism spectrum disorder in the DSM – IV criteria
Per our current state mandate for autism coverage, we as providers, are required to submit any and all diagnostic information to prove medical necessity criteria. Without this, we will not be able to gain an assessment authorization or therapy authorization.
Please have your MD, Psychologist or Psychiatrist provide a prescription recommending ABA Therapy with the diagnosis listed.
Questions to Ask Your Insurance Provider
- Will my policy cover ABA Therapy, Occupational Therapy or Speech therapy?
- Is Behavioral Innovations in-network with my plan?
- Does my policy have a “max out of pocket”, a co-pay, or both? If so, How much will that be?
- Will there be a cap on how many hours of therapy my child can receive on a yearly basis?
- Will I need a referral from my primary care physician for my child to receive services with Behavioral Innovations? (If the answer is yes, then you will need to make an appointment to obtain this referral prior to commencement of services)
- Will I need a pre-authorization prior to scheduling my child’s assessment?
Grants and Financial Aid for Autism Therapy
If you are in need of financial assistance, we have included organizations below that may be able to assist or help offset the cost of therapy or some other needs your child and family may have. Behavioral Innovations has no financial relationship with any of these organizations and we are not familiar with how these programs work. We are making the links below available as a courtesy to parents in need. Please seek assistance from the organization who sponsors the specific program or programs you are interested in. We are also actively involved in promoting ABA to the community, our government, and the world. While we can accept some grants, they must be in ADDITION to an insurance that covers ABA. Unfortunately, we cannot accept them as the ONLY form of payment for therapy.