The first step to helping children with autism is to receive a proper diagnosis of Autism Spectrum Disorder (“ASD”) from a licensed diagnostician. Parents who suspect their child may have autism will want to ensure they have a formal diagnostic assessment, such as the Autism Diagnostic Observation Schedule (“ADOS”) or Child Autism Rating Scale (“CARS”), conducted by their child’s pediatrician, a developmental psychologist, or other qualified healthcare professional. Provision of ABA services to treat ASD does require a formal “F84.0” diagnosis of ASD, including an indication of the severity level (Level 1: Requiring Support, Level 2: Requiring Substantial Support, Level 3: Requiring Very Substantial Support), and a prescription/referral for ABA services from an MD or PhD.
Once a family has received an ASD diagnosis, they can apply for ABA services directly on our website. Upon receipt of your application for services, an Intake Specialist from our team will help you complete your intake paperwork, which gathers basic demographic information, insurance information, as well as medical, developmental, and behavioral information about your child. This information is helpful in developing an individualized treatment plan for your child, specific to his/her skills and behavior goals. Our intake paperwork will also provide an overview of our policies and procedures, and we will collect copies of supporting documentation, such as your child’s clinical diagnosis and proof of insurance.
Once all required intake documentation is received, one of our Authorization Specialists will verify your insurance benefits with your commercial insurance and/or Medicaid payor(s) and confirm that you have coverage for ABA services. They will identify any limits or restrictions to coverage and gather details on any applicable copays, deductibles, or coinsurance, per your insurance plan. When the benefit verification is complete, an Intake Specialist will provide you with a overview of your ABA benefits for your review.
ABA treatment typically requires pre-authorization from commercial and/or Medicaid payors prior to conducting an initial assessment. After reviewing your benefits with you and confirming your desire to move forward with ABA services, one of our Authorization Specialists will submit an initial authorization request to your insurance provider. Once obtained, this initial authorization will enable one of our Board Certified Behavior Analysts (“BCBA”) to conduct your child’s initial assessment.
Once we receive the Initial Authorization from your insurance provider, a Client Care Coordinator will assist in scheduling your child's initial assessment with one of our BCBA’s. During this initial assessment, a BCBA will be speaking with you to explore your child’s abilities and any behavioral issues related to language, socialization, sensory tolerance and motor skills. The BCBA will also be observing and interacting with your child to further assess your child’s language development, practical life skills, and ability to generalize learning across contexts and settings. The BCBA will work together with you to establish behavioral goals and priorities, and partner with you in developing an individualized plan of care and schedule for services that are specific to your child’s and your family’s unique needs.
Once your child’s plan of care is complete and approved by all parties, one of our Authorization Specialists will submit it to your insurance payor(s), along with any required documentation, in order to request a treatment authorization for provision of ABA services. Typically 6 months in duration, a treatment authorization provides pre-approval for a medically recommended level of ABA services to be provided each week, typically ranging from 15-to-35 hours per week depending on a child’s specific plan of care.
Once a treatment authorization has been received, ABA services may begin! Your child’s clinical team will typically consist of one or more Registered Behavior Technicians (“RBT”) who will work alongside your BCBA in providing treatment according to your child’s individualized plan of care. Your BCBA will oversee sessions and continuously modify the treatment program to best ensure your child’s success and progress toward behavior goals and skill acquisition. Your BCBA will also work closely with you in family training, to ensure generalization of your child’s successes across contexts and environmental settings. Together, this clinical team will work with your child and your family to ensure outstanding outcomes for your child and your family!