Behavioral Innovations is dedicated to helping you navigate your Insurance Benefits as smoothly as possible.
Questions to Ask Your Insurance Provider
- Will my policy cover ABA Therapy, Occupational Therapy or Speech therapy?
- Is Behavioral Innovations in-network with my plan?
- Does my policy have a “max out of pocket”, a co-pay, or both? If so, How much will that be?
- Will there be a cap on how many hours of therapy my child can receive on a yearly basis?
- Will I need a referral from my primary care physician for my child to receive services with Behavioral Innovations? (If the answer is yes, then you will need to make an appointment to obtain this referral prior to commencement of services)
- Will I need a pre-authorization prior to scheduling my child’s assessment?
We Can Help!
Would you like us to check coverage on your behalf? We are happy to help! If you have insurance through one of the companies listed above, we can request benefit information on your behalf and contact you to discuss the information your carrier provides. To begin this process, use the online application where you will be asked for a digital copy of the following:
All Insurance Cards, a Diagnostic Report & a Prescription
(click each for more information)
At this time, the only diagnosis recognized for the coverage of ABA therapy is, Autism Spectrum Disorder F84.0.
To obtain authorization for services, we will need you to provide a formal diagnosis report from an MD, Psychologist or Psychiatrist etc. using one of these assessment tools:
Autism Behavior Checklist(ABC)
Autism Diagnostic Observation Schedule(ADOS-2)
Autism Diagnostic Interview(ADI)
Childhood Autism Rating Scale(CARS)
Checklist for Autism in Toddlers(M-CHAT)
Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist(CSBS-DP-IT)
The diagnosis report also needs the following information discussed and assessed
Autism symptoms to include social relatedness
Core ASD symptoms Repetitive or unusual behaviors
Diagnosis of autism spectrum disorder in the DSM – IV criteria
Per our current state mandate for autism coverage, we as providers, are required to submit any and all diagnostic information to prove medical necessity criteria. Without this, we will not be able to gain an assessment authorization or therapy authorization.
More information on this can be found on our Evaluation & Diagnosis page.
Insurance Not Listed
Don’t see your insurance? Please take a moment to send us the name of your insurance provider, as we may be able to become in network with that provider. Thank you!
Behavioral Innovations provides this service as a courtesy. Although we do our best to ensure that the insurance benefits we relay to you are correct, Behavioral Innovations is not responsible for any errors or omissions conveyed to us by your insurance carrier. PLEASE BE AWARE THAT THE INFORMATION WE RELAY FROM YOUR INSURANCE COMPANY DOES NOT GUARANTEE COVERAGE. Only when a claim is received by your insurance company and the carrier determines eligibility, charges, and plan policies, will payment be submitted.
Please note that the legislation in the state of Texas only pertains to insurance policies that are fully-funded. Self-insured insurance policies are governed by the federal government. Although some self-insured insurance policies cover Applied Behavior Analysis (ABA) therapy, there is no requirement by the federal government that requires them to do so