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UnitedHealthcare Military & Veterans – TRICARE | Regence (UMP and commercial plans) | UHC Commercial | First Choice | Premera (including Microsoft and Amazon) | Cigna | Anthem (out-of-network) | Molina Healthcare | Developmental Disabilities Administration (DDA) | Kaiser Permanente (including former Group Health Cooperative) | Providence
This a brief overview of the authorization process as it relates to most insurance plans. We recommend that you contact your individual funding source for their specific requirements.
*Note that all care must be medically-necessary and preauthorized to be covered by the plan.
What is the Pathway to Obtaining ABA Therapy Services?
- The first step is to see a neurologist, pediatric neurologist, developmental pediatrician, psychiatrist, or doctorate-level psychologist for a diagnostic assessment, comprehensive evaluation report, and recommended treatment (if results are positive for autism). This provider must have experience in using evidence-based tools to establish or confirm the diagnosis of autism and experience in developing treatment recommendations that consider the full range of autism treatments, of which ABA may be one component.
*For Medicaid plans, this must be completed by a Center of Excellence
- If ABA is recommended, the next step is to work with your insurance provider to obtain a referral to BASICS NW LLC. There is an initial review of the physician referral to determine whether the individual meets eligibility criteria for ABA treatments (i.e. diagnosis, coverage, presence of autistic behaviors that are having clinically significant impacts on functioning in home, and and/or community. If the individual meets criteria for ABA services, then the initial authorization/referral is made to BASICS NW LLC and will be for the development of an Individual Treatment Plan (ITP).
- Once this referral is made, BASICS NW will work with the family to better understand availability for services and our availability to provide treatment. The individual will then be placed on our waiting list and we will look to begin services when a provider is available to meet the desired request.
- Once a provider is available and a schedule is coordinated with the family, BASICS NW LLC will complete an Initial ABA Assessment/ITP and submit a request for preauthorization for ABA therapy services to your insurance provider.
- The ITP will be reviewed by your insurance provider and, upon approval, an authorization will be granted for, typically, six months of ABA services. Every six months, BASICS NW LLC will need to prepare a new ITP and submit it to insurance for a continuation of services, if discharge criteria have not yet been met.
Services covered through most insurance providers include assessment and program supervision by a Board Certified Behavior Analyst (BCBA) and a number of hours per week provided by an ABA Behavior Technician (BT).
While we do work toward credentialing with a number of insurance providers, we encourage families to contact their own insurance providers to determine whether they are entitled to coverage for Applied Behavior Analysis services.
BASICS NW does not initiate services until such time that families are able to provide confirmation of benefits. While we work with funding sources and families to verify coverage, understanding of such benefits and obligations based on each individual plan is the sole responsibility of the family seeking to initiate services.