Insurance
ABA services are costly, and we encourage all families to take advantage of their insurance benefits!
Our agency is out-of-network with all insurers, meaning that families pay us at the end of each month for services, and then submit for reimbursement. If your plan is written in the state of New York, and you have out-of-network benefits, you likely have ABA benefits.
Please note that we will not work with United-Oxford, even on an out-of-network basis, due to their business practices towards small business and children with autism. https://www.cnn.com/2024/12/14/health/unitedhealth-children-autism-propublica?cid=ios_app
What should I do to find out about my insurance benefits?
Please call our office. If we have availability and your child fits the profile we serve, our insurance expert will review your plan and let you know what to expect. She will also inform us of what is needed to maximize your reimbursement.
What happens next?
If you are interested in moving forward, we will arrange an initial consultation. This is an informal meeting where we meet you and your child, serving as an opportunity for us to share our treatment philosophy and discuss ABA research. This is an observation, not a formal evaluation, and it lasts about one hour. After meeting in-person we are better able to explain the type of goals we will target first for your child. Our flat fee for this meeting is $225.
Once you decide our agency is a good match for your family, we pre-authorize a more formal assessment. This usually takes 8-12 hours. A BCBA will come and assess your child’s ability with a variety of developmental milestones and write a lengthy report to your insurance company detailing the goals we will work on for the next six months.
Our office then submits that report for review by your insurance company. Once approved, we typically receive a six-month authorization. Some policies provide one-year authorizations and a few do not require authorization. However, we always start with an assessment and report to make sure we are creating the best path forward. The vast majority of insurers will not reimburse for ABA services if the service is not pre-authorized.
Individualized Treatment Plans
One of the biggest advantages of using BCBAs to service children directly is that our treatment plans are individualized and tailored solely to your child. No two plans are identical even though children on the spectrum usually require goals in the areas of language, social skills, toy play, and addressing behavioral excesses and deficits.
We will work on the plan created for six months and begin treatment as soon as the report is submitted! If you are most comfortable waiting until we have approval, there is approximately a two-week lag between when the report is finished and when daily services start.
How much will I be reimbursed?
We will always relay information we receive from your insurer. Please understand that we do not control reimbursement rates! This is determined by the contract your employer has with the insurer. Most of our clients receive between 40-100% of our fees.
How long does it take to be reimbursed?
Although this is beyond our control, in our experience it is about six weeks from the time a claim is submitted until the claim is processed.
I’m debating between insurance plans. Can you advise which is better for ABA services?
We sure can! Please contact us.
