TriCare & ECHO Authorized Services

All services are performed by a Board Certified or Board Certified Eligible individuals under the guidance of a NC Licensed Psychologist. The Extended Care Health Option (ECHO) is a supplemental program to the basic TRICARE program. ECHO provides financial assistance for an integrated set of services and supplies to eligible active duty family members, including family members of activated National Guard or Reserve members.

Eligibility for TriCare Autism Demonstration Project:

  1. Age 18 months and older
  2. Registered in the Extended Care Health Option (ECHO)
  3. Diagnosed with one of the following:
    • Autistic Disorder (AD)
    • Childhood Disintegrative Disorder (CDD)
    • Asperger's Syndrome (AS)
    • Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS)

 

If diagnosed before this demonstration began (March 15, 2008), children do not need to be re-diagnosed.

 

To inquire about TriCare programs please speak to your local TriCare representative. You must be pre-approved through ECHO prior to beginning services.

Standard ECHO Program:

Services are provided by a BCaBA or BCBA.  Services include, but are not limited to, programming, training, tutoring and consultation. Carolina Center for ABA and Autism Treatment submits claims for services and families are responsible for their pre-determined, monthly co-pay.

ECHO Demonstration Project:

Functional Language Tutors provide intense 1:1 training under the direct programming of a Board Certified Consultant. Consultation and family training are provided in conjunction with 1:1 Tutoring. Both clinic-based and home-based services are available. All services must be pre-authorized by Tricare/ECHO. Carolina Center for ABA and Autism Treatment submits claims for services and families are responsible for their pre-determined, monthly co-pay.

Moving from out of state?

There are currently 28 states that have legislation requiring ABA services be covered by insurance companies:

Arizona Iowa Montana Rhode Island
Arkansas Kansas Nevada South Carolina
Colorado Kentucky New Hampshire Texas
Connecticut Louisiana New Jersey Vermont
Florida Maine New Mexico Virginia
Illinois Massachusetts New York West Virginia
Indiana Missouri Pennsylvania Wisconsin

 

If you're moving from one of these states and had health coverage for ABA services for your child it's possible that your insurance provider will continue coverage for your child through our clinic. We have had experiences with some providers who enter into "single case agreements" with us and with a family in order to help cover services. This is contingent upon the insurance provider and our clinic being able to agree on a rate of reimbursement.
Please contact your out of state provider in order to discuss out of state coverage.

 

Currently, Carolina Center for ABA and Autism Treatment will file on behalf of your family. We will submit the paperwork in order for you to receive reimbursement. We ask that you address your bills as they arrive or set up a plan with the Director in order to address your balance while awaiting reimbursement.

 

What to ask for?

The most important thing to ask your insurance company is whether or not they will cover your child’s specific diagnosis. Many companies will cover autism however there are some employer based insurance plans that exclude autism from their coverage.
Some companies will not specifically cover ABA however they will cover individual psycho therapy. Start by asking what services they will cover under your plan for a dependent with a diagnosis of Autism. This will better guide them in telling you what will and will not be covered. Make sure you ask what it means for a provider to be certified. Many of our consultants are at the BCaBA level but only a few at the BCBA level. Some plans will only cover the BCBA while some will only cover someone with a medical license such as an LPA psychologist. In order to provide you with services covered by your plan this is information we need prior to beginning services. In order for services to be covered by your insurance plan you must obtain authorization through the insurance company. This is required prior to beginning services. It is also important to request that they inform you of what CPT Billing Codes to use when filing with insurance. It is best to know all the necessary information prior to starting services to ensure that insurance will in fact cover the charges.