Frequently Asked Questions Regarding Insurance and Billing
1.How can I access ABA therapy for my child?
In order to be eligible for ABA services under ARICA, a client must have three of the following documents ready for our billing team to obtain an initial authorization for ABA services.
- Proof of Physical: Evidence of a physical examination by a medical provider within the last 12 months.
- Full Diagnostic Report: ull Diagnostic Report: A report from the diagnosing clinician, usually a psychologist or neuropsychologist, that clearly identifies the client’s diagnosis and evaluation results.
- Letter of Diagnosis: A letter signed by a diagnosing clinician that confirms an Autism Spectrum Disorder diagnosis. The letter must also state that ABA therapy is medically necessary for the client to make progress.
2.What is a co-payment?
This is the amount you pay at the time of service. A co-payment is billed to you for each visit, no matter the number of hours per session. If you have more than one session in a day (i.e., one in the morning and one in the afternoon), you will be billed a co-payment for each session.
3.What is a deductible?
This is the amount you are responsible for paying before your insurance begins to cover your healthcare costs. Deductible payments are to be paid at the time of service until the balance has been met.
2.What is a co-payment?
This is your share of the costs of a health care service. Co-insurance is a percentage of the total charge for the service.
4.What if there are changes to my insurance?
You are responsible for knowing when there are changes to your insurance or coverage. If your insurance changes, please notify us immediately and before your next session so that we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim, any rendered services that are not covered by your insurance will be billed directly to you after 45 days.
6.What if I can’t afford my child’s therapies?
There may be other funding sources. Ask your BCBA about community grants available to support payment of medical expenses or treatment modalities. Some have been provided here for your convenience. Additionally, the organizations below may have updates to what they may provide. This is not an exhaustive list.
6.Where can I learn more about insurance funded ABA services?
- Massachusetts families may visit the Autism Insurance Resource Center’s websitehttps://www.disabilityinfo.org/arica/
- The Doug Flutie, Jr. Foundation for Autism, Inc. Family Grant Programhttp://www.flutiefoundation.org/joeys-fund-family-grant-program
- Charitable Grants for Individuals With Autism & Their Families – Outreach autism Services https://moutreachautismservicesnetwork.com
- United Health Care Children’s Foundation grant applicationhttp://www.uhccf.org/apply/
- House of Possibilities – Hope Scholarshiphttp://www.houseofpossibilities.org/scholarship-program