FREQUENTLY ASKED QUESTIONS
Q: ARE YOU IN-NETWORK WITH INSURANCE COMPANIES, AND IF SO, FOR WHAT SERVICES?
A: The SEED Center is in-network for ABA services with:
- Optum Behavioral Health, which includes: United Healthcare, Oxford, Conneticare and UMR.
- Aetna, which includes: Coventry and First Health.
The SEED Center is out-of-network with all other insurance companies, and for all other services. Out-of-network services we offer include: Psychological, Speech and Language, and Occupational Therapy services.
Q: WHAT ABA SERVICES TYPICALLY GET AUTHORIZED THROUGH INSURANCE?
A: Insurance companies typically authorize a combination of 4 distinct, but overlapping services required for ABA Therapy:
- Direct by Behavior Technician. This service is the direct time that the behavior Technician provides ABA Therapy to the client. For every 10 hours of Direct by the Behavior Technician, the Board Certified Behavior Analyst (BCBA) or Licensed Mental Health Professional (LMHP) is typically required to provide 1 hour of supervision.
- Supervision by BCBA or LMHP. This service is provided while the client is receiving services from the Behavior Technician. During supervision, the BCBA or LMHP ensure the fidelity of the ABA program by ensuring the interventions are being implemented, and data is being collected, consistently and in the manner described in the program.
- Direct by BCBA or LMHP. This service is provided by the BCBA or LMHP directly to the parent or caregiver. During this time, the BCBA or LMHP provide training so that ABA strategies and interventions that have been successful in the client’s sessions with the Behavior Technician can be carried over when the Behavior Technician is not present. For every 10 hours of Direct by the Behavior Technician, 1 hour of Direct by the BCBA or LMHP is provided.
- Assessment and Treatment Planning by a BCBA or LMHP. This service includes: reading, reviewing, and sign off treatment notes, creating materials, inputting and graphing data, updating data sheets, and modifying treatment plans. A minimum of 1 hour of treatment planning is required for every 10 hours of Direct by the Behavior Technician. While this is not a face-to-face service with the client present, it is required for an ABA program. Deductibles, co-pays and/or co-insurance apply to services without the client present.
Q: WHAT IS REQUIRED TO BEGIN SERVICES THROUGH MY INSURANCE?
A: An autism diagnosis is required in order for insurance to consider authorizing and covering services.
Please provide the Admissions Coordinator a copy of the front and back of your insurance card and a copy of the original Diagnostic Evaluation, as both will be necessary to obtain an authorization.
Q: DO YOU CONDUCT AN ABA ASSESSMENT?
A: Yes. The appropriate ABA assessment selected is based on the individual client needs.
The assessment is the foundation of the ABA program and is used to determine the focus of the ABA Therapy. The assessment guides the clinical rationale for services, and the number of ABA service hours to request for authorization.
Q: HOW LONG DOES AN ABA ASSESSMENT TAKE?
A: ABA assessments are typically a total of 8-12 hours:
- 1-hour appointment with the client/guardian(s) to obtain background information.
- Approximately 2-4 hours of assessment, typically scheduled in two sessions.
- Approximately 2-4 hours for without the client present for: scoring, report writing and developing the Treatment Plan and ABA Program Book.
- 1 hour for a feedback meeting to go over assessment results, recommendations for services, schedule for on-going services and start date.
Q: HOW MANY HOURS OF ABA GET AUTHORIZED?
A: The number of hours the insurance company approves is different for each individual.
Some factors that impact hours include: clinical rationale for services, age of the individual, severity of the skill deficits, previous progress with ABA services, and other ABA services being received in school.
After the ABA assessment has been completed, the Admissions Coordinator will send your insurance the completed treatment plan and a request for authorization of ABA services. The hours requested are based on the level of need reflected in the ABA assessment.
Q: WHO IS RESPONSIBLE FOR THE REAUTHORIZATION OF ABA SERVICES?
A: The BCBA or LMHP serves as your Case Manager and will prepare the reauthorization paperwork, and review it with you prior to submitting to the insurance company.
Reauthorization is typically due every six months. During reauthorization, a report of progress is generated, the treatment plan is updated, and a recommendation for continued services is made along with the number of hours being requested. During reauthorization, the number of ABA hours can be increased or decreased depending on client progress and the clinical rational for continued service.
Q: WHAT ARE THE TREATMENT CODES FOR ABA THERAPY?
A: Insurance companies use different treatment codes for ABA Therapy.
For more information on what codes your insurance company uses, please speak with the Admissions Coordinator or your assigned Case Manager.
Q: WHAT IS MY FINANCIAL RESPONSIBILITY?
A: You are responsible for co-pays, coinsurance and/or deductibles, which is determined by your insurance company.
You should contact your insurance company to ensure you fully understand your insurance plan. The SEED Center submits invoices to insurance for in-network services, and all copayments, coinsurance and/or deductibles are due at the time of service.
Q: WHAT IF YOU DO NOT ACCEPT MY INSURANCE OR I NEED SERVICES THAT ARE OUT-OF-NETWORK?
A: We accept private pay options; including cash, checks and major credit cards.
If you have out-of-network coverage with your insurance, you may be able to submit the paid invoices to your insurance company.
You can check with your insurance company to better understand you’re out of network coverage.
Q: ARE ABA SERVICES MANDATED IN CT AND NY?
A: Both CT and NY have state mandates for the coverage of ABA Therapy for the treatment of autism.
To find out more information regarding state mandates, please follow this link: http://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx