What should parents should know about insurances while getting ABA services for their children
What is Prior Authorization?
Prior authorizations are required for many types of medical treatment, including ABA. If you are interested in ABA, your insurance plan may require prior authorization before they will cover the cost of treatment.
Prior authorizations do not guarantee coverage for every treatment or therapy. However, for ABA programs, the general criteria that insurance companies use is that your child be of a certain age (state mandates again), and that you child has an official diagnosis of an Autism Spectrum Disorder.
In addition to meeting their eligibility criteria, each provider will need to determine their specific authorization process and submit these requests accordingly.
The Insurance Authorization Process:
The process of obtaining authorization for ABA therapy can be long and complicated, but it is well worth the effort. The first step? Assessment.
A BCBA will conduct an assessment of your child’s skills and behaviors in order to determine where the gaps are and how an ABA program can address those needs. After the assessment is completed, the BCBA will make a recommendation for how many hours of treatment your child needs and write the individualized treatment plan.
To obtain an authorization for ongoing ABA services, your provider will send the treatment plan to your insurance company along with a request for how many hours of treatment they are recommending for your child. Once approved, the insurance company will typically* authorize treatment for six months at a time. In these instances, around 5 months into treatment your BCBA will re-conduct those assessments again, update the treatment plan and recommendations as necessary, and re-submit everything back to the insurance company for another authorization for the next 6 months. That process then repeats itself for the duration of your child’s treatment.
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