Navigating Insurance and ABA Therapy: A Roadmap For Parents

Navigating insurance after receiving your child’s autism diagnosis can feel like an overwhelming process, but it’s important to know that you’re not alone. Trumpet Behavioral Health can help you determine your coverage for autism services and eligibility for ABA benefits. While working with your insurance provider might feel challenging, having a roadmap to navigate the process can help you make informed decisions for your family and your child. Here are some tips as you explore gaining insurance coverage for autism therapy.

Where To Start

Thankfully, you have options when starting the conversation about your autism therapy benefits:

Contact your insurance provider directly to determine a list of in-network providers. While this is a good way to assemble a complete list of autism services providers in your area, you will still need to do your own research to determine which providers are BCBA credentialed
Contact local providers directly to determine if they are contracted with your insurance

At Trumpet, a representative can give you an immediate determination of your contract status. We can also obtain your insurance information to verify your ABA coverage and to provide you with an estimated cost of services.

Authorization Process

Referrals or prior authorization are usually not required for ABA therapy approval, but most insurance providers will require a diagnosis of Autism Spectrum Disorder from a certified provider, such as an MD or PSYD. IEP’s from a school district are typically not sufficient for a diagnosis. Any additional enrollment documents will vary by ABA provider. During our intake process at Trumpet, we strive to make the authorization process as smooth as possible for you. We will collect all documentation required by your insurance provider, and our dedicated authorization team will request approval on your behalf. If any additional information is required, our intake team can further assist you with obtaining necessary documents.

Payment Options

During your complimentary financial consultation with Trumpet’s dedicated representatives, we will discuss contract status, benefit details, estimated cost of service, and payment options. You will be provided with an estimated cost of service based on the average number of hours recommended for your child. At Trumpet, payment is not due at the time of service rendered. So once your first bill is received, typically within a month after services have begun, you can discuss a payment plan with a dedicated member of our family accounts team.

Addressing Gaps In Coverage

It may be the case that your employer-based insurance does not cover ABA therapy. You have several options here. First, you should contact your HR department to discuss options for a different policy that includes ABA coverage, or to discuss adding additional coverage to your current policy. If this is not an option, then you can look into local alternatives like Medicaid policies, regional centers, and scholarships for assistance with funding. During your complementary financial consultation with one of our representatives, Trumpet can discuss alternative options for coverage, as well as additional options for proceeding with ABA services through a self-pay agreement.

Changes To Insurance

If you have an upcoming change to your insurance, it’s best to be proactive. You can contact insurance@tbh.com to verify that we are a contracted provider with your new policy. If so, we will obtain your updated member information, and then can verify your updated coverage, provide you with a new estimate of services, and work directly with your insurance provider for authorization. If we are not contracted with your new policy, we can review options for additional funding or self pay, or we can assist you with identifying an in-network provider.

Trumpet’s Approach To Insurance

At Trumpet, we recognize that navigating insurance can be a stressful experience, and we want to ensure you feel supported throughout the process. To this end, TBH has dedicated home office employees who specialize in intake, authorizations, claims, insurance, and billing. We want your child and your family to come first, so our representatives work proactively to verify your coverage and network status, and can quickly notify you of any changes or issues. Ultimately, we strive to make navigating insurance a smooth process for you, ensuring your child receives holistic, compassionate ABA therapy through Trumpet’s BCBA therapists.