How to Navigate Insurance to Obtain Services for Your Child

The world of insurance is a tricky maze to figure out alone. Don’t do this on your own! Let us help!

Step 1 Documented Diagnosis

Receive a written diagnosis from a medical (M.D. or D.O.) or licensed psychologist (PsyD., Ph.D.). Some insurers will only want a prescription from your pediatrician and will not request a full diagnostic report. A school report or IEP does NOT count as a diagnostic report. 

Step 2 Understand Your Policy

You can call the benefits department from your insurance provider (number is located behind your insurance card) and ask if ABA Is a covered treatment. Some insurance plans do not cover ABA and some do. During this time, you can also ask about your co-pays and deductibles. If your insurance does not cover ABA, you can reach out to your local Regional Center for assistance for services.  However, at Behavior Trend, we can do this step for you to verify your benefits and eligibility for ABA services. 

Step 3 Document and stay organized

Stay on top of all the documentation you gather during steps 1 and 2 (any reports, assessments, bills, explanation of benefits (EOBs), and communicate with your insurer). They will come in handy!

Step 4 Pick your ABA Provider Carefully!

When looking for providers, it is essential not to go with the first provider suggested to you but to find one that fits you and your family. “It takes a village”.  Pick a provider who has developed relationships with other service providers such as speech therapists, clinical psychologist, and advocates and who has a successful working relationship with insurers. We partner with many local and national resources and would be happy to make referrals when necessary. 

Ensure that a Board-Certified Behavior Analyst (BCBA) is leading your ABA programming (writing goals), not a non-certified staff. The BCBA should be your main contact. 

Step 5 State-specific laws

It is essential to know that every state does not adhere to the same insurance laws regarding ABA services. It is vital to know your rights!  In California, ABA services was a requirement to be covered through insurance for children with autism through S.B. 946.

Step 6 Ready to start this Maze?

Contact us and we will have you speak to our insurance experts! We will take all the information you have gathered from step 1-5 and help you with the process of starting ABA services using your insurance policy! Don’t do this on your own! Let us help.

It can be scary and possibly even overwhelming, looking at all the paperwork and information you have gathered, but you are not alone. We will help guide and coach you through every twist and turn of the insurance maze.

We provide services in Los Angeles County, Santa Barbara County, and San Luis Obispo County. 

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