Inside ABA Therapy Insurance: Top Tips for Parents

Insurance can be a bear to navigate when it comes to the life-changing treatment of Applied Behavior Analysis (ABA) therapy. It wasn’t until last year that all 50 states finally had statutes on the books, requiring insurers to cover some level of treatment for autism spectrum disorders.

Still, there are many differences in coverage from state to state, insurer to insurer, and plan to plan as to what “some” means and “treatment” includes.  

For a quick snapshot of each state’s laws and links to the actual legislation, this site is a great place to start. For help with various insurers and plans, it’s a matter of shopping around or contacting your current plan provider. Even then, it can be confusing and stressful for parents who just want straight answers so they can provide the best for their child.

Go to the Source for Expert Advice

The easiest, most direct way get the scoop on ABA therapy insurance coverage is to seek the guidance of a trusted ABA therapy provider. Here at The Behavior Exchange, we’re an insurance advocate for clients. We work with insurance companies everyday and know how to maximize therapy benefits for families.   

Below, we’ve compiled a list of our top 7 insurance tips for parents. Hopefully, these tips will provide answers you’ve been looking for or spark other important questions to ask. With the prevalence of autism tripling over the last 20 years, it’s more important than ever children and families receive the ABA therapy and insurance support they need to reach their full potential in life.

Our Top 7 ABA Therapy Insurance Tips

1)   Check your child’s diagnosis report.

Most insurance companies require a standardized assessment conducted by an MD (medical doctor) or licensed psychologist. A school report is not enough. You’ll need a comprehensive diagnostic report completed within the last two years of when you’re seeking insurance coverage. If the cost is prohibitive, wait until you’ve reached your insurance out-of-pocket maximum for the year.

In addition, be sure your report includes the diagnosis code for autism spectrum disorder (F84.0). That’s very important. You’ll also need a recommendation for ABA therapy directly from your diagnosing physician to qualify for coverage

2)   If your insurance excludes ABA therapy, you have options.

Many insurance plans include ABA therapy nowadays. However, if yours does not, consider talking to your employer about adding the benefit for next year. Another option is to purchase a child-only plan through a federal or state insurance marketplace or directly from most health insurance companies.

3)   Don’t forget about your out-of-pocket maximum.

 Parents new to ABA therapy tend to concentrate on the copay or coinsurance that is due every visit. It’s better to think about costs on an annual basis, because ABA therapy is intensive, meaning children often spend up to 40 hours a week in therapy. Once you meet your out-of-pocket maximum (the most you’ll spend in a year on services), copays and coinsurance will no longer apply.

4)   Insurance companies can limit the number of hours they cover.

Just because your insurance plan covers ABA therapy doesn’t mean it will cover as many as hours of therapy as you want for your child. Most plans require prior authorization, which is the process of determining how many hours of therapy are medically necessary for your child. For example, insurance will only pay for 40 hours a week if they believe your child needs that level of care.

Your doctor and ABA therapy provider can provide you with recommendations on how many hours of therapy your child requires. But ultimately, the insurance company has it’s own criteria for what is medically necessary. Sometimes they’ll agree with the recommendations from your doctor and ABA therapy provider, and sometimes they won’t. That’s where an ABA therapy provider can advocate on your child’s behalf.

5)   Tell your ABA therapy provider IN ADVANCE about changes to your insurance.

You want to avoid any out-of-pocket costs that can add up quickly when you change insurance companies or plans. As we mentioned before, not all insurance providers have the same coverage and their requirements may differ. Proactively giving your ABA therapy provider a heads up can save you the headache of scrambling to gather information.

6)   Allow your ABA therapy provider to coordinate with other service providers.

Working together with your child’s school, speech therapist, and occupational therapist helps your ABA therapy provider demonstrate to your insurance company the medical necessity of ABA services for your child.

7)   Participate in parent training.

Insurance companies want to see you involved in your child’s ABA therapy. They actually require that you receive parent training in order to continue authorizing ABA therapy for your child. It’s a great idea regardless, because parent training empowers you to help your child in real life situations at home and when you’re out and about in the community.

We’ve Got You Covered

The Behavior Exchange is an in-network ABA therapy provider with most insurance companies in Texas and Colorado. The relationships we’ve built with insurers over our 20-year history have helped to maximize care and outcomes for clients.

For more information about our services or to request a quote of insurance benefits, contact us online or call 972.312.8733. We’re happy to help with your questions from insurance to Telehealth ABA and everything in between. Thanks for reading!

Categories

Categories

Archives

Archives

Covid 19 Update

Safe hives. Changing lives.

Learn how we’re keeping our hives safe, healthy, and buzzing with hope!

 

Click here for details

As Director of Finance, Robert manages and oversees financial planning and accounting, revenue cycle management, budget operations, and strategic initiatives for The Behavior Exchange. He brings more than 15 years of experience to his role and is accomplished at developing financial strategies that enhance organizational growth and maximize sustainability. Robert’s expertise includes the design of short- and long-term financial plans, investment management, De Novo strategy, operational optimization, financial problem solving, compliance, and much more. But he’s not all “Show me the honey!” Robert is as comfortable handling transaction and valuation service engagements of more than $100 million as he is driving a classic dune buggy to work.

Ashvina attended University of Bombay and graduated with a Bachelors of Commerce. She got her Montessori Diploma in 1985 and taught ever since. Ashvina came to TBE in January of 2016 as Admin Assistant. During the years she got the opportunity to learn and work in different departments such as HR, Finance, Office Manager and Executive Assistant. Last summer TBE bought billing in house and her current focus area is Revenue Cycle Management. She is detail oriented and enjoys working with people. Ashvina volunteers to deliver meals to seniors and local shelters on the weekend. She loves to spend time with her family and grandkids. Ashvina loves her job because she enjoys hearing different points of view, and she feels her contributions help fuel the direction of our company.

Working with children comes naturally to Angela. Her mom was a special education teacher for 30 years and often had Angela join her for Take Your Child to Work Day. And in high school, Angela spent every summer as the nanny for a little boy with an autism spectrum disorder. It was this experience where her passion for working with children with autism started to blossom.

From there, she went on to graduate from Oklahoma State University with a Bachelor of Science in Human Development and Family Sciences. She learned about Applied Behavior Analysis (ABA) in a non-normative development class and from that moment knew that ABA would be her life’s work.

Angela moved to the DFW area shortly after and began working at The Behavior Exchange as a therapist. She worked on her Master’s in Behavior Analysis at the same time. A year after graduating, she earned certification as a Board Certified Behavior Analyst.

Now, as a Clinical Director at The Behavior Exchange, she brings a life-long passion to her work, holding a special place in her heart for children with limited language skills and working closely with families to develop healthy sleep habits.

Danielle’s passion for working with families is deeply personal and from the heart. Her younger brother has an autism spectrum disorder, and through their journey as a family, she found her purpose in life as an advocate for individuals with special needs.

After graduating from the University of North Texas with a degree in Human Development and Family Studies, Danielle began volunteering at The Behavior Exchange. She saw passionate therapists, meaningful change for clients, and families with hope for the future. After a summer of volunteering, she officially joined the team as Director of Admissions and found her home with The Behavior Exchange family.

With her extensive experience working as a client advocate with insurance providers, Danielle perseveres to help individuals of all ages and abilities receive the services they need to reach their full potential. She feels truly honored by each and every family who entrusts The Behavior Exchange to be part of their journey and is committed to the organization’s core values, mission, and goal of being a beacon of hope for the community.

Adam has always had a passion for helping individuals of all ages thrive and reach their full potential. He’s also an enthusiastic musician, songwriter, leader, and devoted family man, who has been helping children and team members grow with The Behavior Exchange since 2010.

Prior to joining the team at The Behavior Exchange, Adam was a mortgage loan consultant and grad student, pursuing his master’s degree in Education at the University of North Texas. He graduated in 2013 and also earned a graduate academic certificate in Autism Intervention. The following year, after years as a Behavior Therapist and seeing first-hand the power of ABA and the meaningful impact it can have on children and their families, Adam became a Board Certified Behavior Analyst. He then commenced from the Stagen Leadership Academy after completing the Integral Leadership Program (ILP), a 52-week practice-based program designed to develop executives serious about transforming themselves, their teams, and their organizations.

Adam is truly grateful to be a part of a dynamic, inspiring and compassionate team, and he’s dedicated to bettering the lives of all children and their families through the delivery of the highest quality of ABA services, while supporting the amazing team at The Behavior Exchange.

As Supervisor of Technology, Marvin is charged with the creation of strategic IT initiatives that align with the mission, culture and long-term goals of The Behavior Exchange. He works closely with Directors, BCBAs (Board Certified Behavior Analysts), RBTs (Registered Behavior Therapists), and administrative staff to deliver innovative technologies and services that enhance teaching, learning, research, and client activities.

Marvin’s commitment to the success of The Behavior Exchange and its clients has resulted in improved data collection, analysis, mobile device management, and cloud-based file management infrastructure. Marvin graduated form the University of Texas in San Antonio with a BA in Psychology 2004. After graduating, Marvin wanted to give back to his community by dedicating his time commitment to provide a civil service. Marvin for which he commited 8 years to be a probation officer in Bexar County Tx. When the opportunity to join The Behavior Exchange arose Marvin jumped at the chance to continue to provide services for those in need and to work for an amazing organization and cause.

Soraya is from South Africa and moved to Texas in 1996. She graduated from The University of Texas and pursued a career, at that time, in Education. Soraya taught at a Montessori school for a few years and then took on a leadership role.

During her time in the education system, Soraya realized her passion was to assist children with special needs. So she joined The Behavior Exchange as a therapist, transitioned into a supervisory role in 2017, and a year and a half later, was promoted to Clinical Operations Manager.

She quickly learned the ins and outs of ABA operations and scheduling and successfully collaborates across departments to ensure The Behavior Exchange continues to provide quality services to clients and their families. She’s thankful to be part of such an amazing organization and excited to see what the future holds.

You could say Walter’s career started when he spent hours as a young child drawing superheroes and coloring maps. This passion, along with extraordinary swimming skills, landed him a full swimming scholarship at Texas Christian University, where he graduated in 1997 with a Bachelor of Fine Arts in Communication Graphics.

During the next 13 years, his design and art direction skills, conceptual-thinking abilities, and marketing-savvy know-how were honed at a few prestigious advertising and marketing agencies around the Dallas area. In the mid 2000s, he helped his wife Tammy Cline-Soza (founder and CEO of The Behavior Exchange) create a unique and concise brand for her new business. From logos and websites to uniforms, brand voice and visuals, Walter has been the main creative force for all things The Behavior Exchange.

Aside from giving birth to The Behavior Exchange brand, Walter is helping Tammy raise two amazing, beautiful children, River and Sierra. In his spare time (the two minutes he’s got per week), you can find Walter illustrating iconic landmarks of Dallas and Texas or looking around for this next open-water swim. Once he gets back in shape.

After 20 years of building The Behavior Exchange, literally from the ground up,
Tammy couldn’t be more proud of the team, culture, and organization that it has become.

As a family helping families, The Behavior Exchanges looks for opportunities that will make the biggest impact and produce life-changing outcomes – for clients, families, and even for team members. Tammy believes that if a team, a family, a community takes care of each other, the possibilities are endless and the relationships built along the way can make life more enriching and challenges easier to navigate. You could say her goal has been to build a kind of utopia full of support, love, and expertise that brings the best services possible to the community and ensures more families have access to those services.

Tammy and her family have dedicated their lives to the mission of The Behavior Exchange and continue to grow, learn, cultivate, challenge, support, and create better models for success. To that end, she is committed to her own leadership development and actively participates in advanced training, mentoring, and deep self-exploration on how to live out her purpose to love and support her family and help others reach their full potential. She takes her position very seriously and tries to serve as a channel for what the universe wants to come to fruition.

She also loves travel, gardening, being creative, MUSIC!, tennis, yoga, meditation, journaling, reading, being in nature, adventures, and more than anything, spending time with her husband Walter and their two beautiful children, River and Sierra.