Dealing With Insurance to Cover ABA Therapy

Does the center offer support for dealing with insurance companies and helping you navigate the insurance process?

Dealing with insurance by yourself can be a nightmare. Many insurance companies can prove to be difficult when it comes to covering ABA therapy. That is why it is so important that a quality ABA center has someone on their administrative staff who is dedicated to dealing with insurance-related issues, processes, and questions.
When going through the ABA therapy coverage process, you will likely have many questions. You want someone on your team who is thoroughly familiar with the ABA coverage process. This ABA coverage expert will know what kind of documents you need, what kinds of obstacles you might run into in getting coverage, and how to overcome those obstacles. A quality ABA center should have someone with this skill set on staff and readily accessible to all families. This way, every parent or caregiver who comes to the center will have an insurance expert on their team.
What if your insurance decides to deny coverage in the middle of therapy? Would your child be immediately denied services if insurance won’t pay anymore? You might want to ask them about how they have handled scenarios like this in the past. A quality ABA center would have their ABA coverage expert help you work through a situation like this and work through the appeals process.

Does the center call you back?
When you call the center to inquire about services, how good are they at getting back to you? Were they prompt? Did you have to call back multiple times?
If a center is not calling you back after you inquire about services, that is generally a bad sign. The intake team might be too disorganized and chaotic to promptly call back new inquiries. In this case, this is an ABA center that you will want to avoid.

Does the center provide a clear and comfortable intake process?
The process of giving you a tour of the center, collecting information about your child, providing a therapy program proposal, and ultimately enrolling your child is all part of the intake process. The intake process is essentially the process you go through to enroll your child at an ABA center. You, as a parent or caregiver within the intake process, should be able to answer these questions:

• Are you on a waiting list for enrollment?
• Are you waiting to hear about your insurance coverage?
• Does your child have a start date yet?

You should be able to easily answer all these questions if the intake process is well-communicated and transparent. If you can’t answer some, or all, of these questions, you might need to re-evaluate the ABA center you are working with. A confusing intake process is a symptom of deeper problems within the ABA center’s management and potentially their therapy overall

Does the center have a family outreach/support person to answer questions and provide resources no matter what?

Getting ABA services for your child can be complicated to say the least. An quality ABA center will be there to guide you and answer your questions about autism and autism resources, even if your child does not go to their center.
A family outreach or family support coordinator is someone at an ABA center that families can rely on to answer questions about ABA, finding autism resources in the community, and referring to other agencies if needed, and more . For instance, the family outreach coordinator should be able to answer the following:

• Where you can go for a dentist that works with patients with autism?
• Who are the local doctors that do autism testing and what are their respective wait times?
• Are there different resources in the community for children versus adults?

Without the family outreach/support component, an ABA center won’t be serving the community as well as they could. A lack of family support resources can show you that a center is not very interested in helping families in the community.

Does the center stop talking to you if you don’t have insurance coverage?
You can quickly get a sense for how much a center is focused on your insurance coverage, not your child, when you first speak with them about services. How quickly do they ask you about what insurance you have? Is it among the first 3 questions they ask you?
Generally speaking, if the ABA center staff ask you about insurance before discussing anything else, it shows you what is most important to them. You can imagine that an ABA center like this might see you as a big stack of money. You’ll want to avoid such a provider, because they will not be focused on doing what is best for your child and your family. This type of ABA center will do what is best for their bottom line before they consider you.
Another great way to tell if the center only cares about finances is to see what happens after they find out that you don’t have insurance that covers ABA. Do they quickly end the conversation and get you off the phone? Do they not return your calls afterwards?
An ABA center that puts the needs of the community first will not abandon you after finding out you don’t have coverage. Instead they might:

• Show you the various options for coverage such as buying a policy.
• Offer to add you to a list for updates as changes might occur with insurance or open enrollment.

The time and effort that goes into training and safety can tell you a lot about the quality of an ABA center. Let’s take an in-depth look at some of the training and safety practices that ABA centers should be using to provide quality, ABA therapy services.

Therapists that are working 1 on 1 with children should have a bachelor’s degree in a related field

When it comes to the therapists that will be working 1 on 1 with your child, it’s important to know that they have the right credentials. ABA therapists ideally should have a bachelor’s degree from an accredited university or college. The ABA therapist’s bachelor’s degree should be in psychology, education or a related field. If they do not have a degree, they should at minimum have a broad base of experience working with children with autism, with additional training provided by the ABA Center.

Therapists that are working 1 on 1 with children should be Registered Behavior Technicians

Registered Behavior Technician(RBT) is the standard certification for ABA therapists that work 1 on 1 with children with autism. The RBT certification is the first level of certification from the Behavior Analyst Certification Board. If you find out that a center’s ABA therapists are not RBTs, then you should see that as a big red flag. To give you an idea of how important the RBT certification is: Medicaid in Indiana will not cover ABA therapy that is not performed by an RBT.

Your child’s program should always be supervised by a BCBA, or at a minimum a BCBA in training, with constant supervision from a BCBA.

The clinicians overseeing your child’s whole therapy program should be Board Certified Behavior Analysts(BCBA), or at least someone who is working towards becoming a BCBA. Anyone working towards a BCBA is required to be directly supervised by a BCBA.
A Board Certified Behavior Analyst is the graduate-level certification from the Behavior Analyst Certification Board. Someone who is certified at the level of a BCBA is an independent practitioner, with a master’s degree, clinical training, and has passed a board exam, who can provide behavior analysis services.
What is a Board Certified Behavior Analyst in training? Ideally, it is someone who has completed their master’s degree, is being supervised by a BCBA, and is going to sit for their BCBA exam within the next 12 months. According to the certification board, most people working towards their BCBA certificate are required to be supervised by a qualified BCBA for nearly a year.
This is important to know, because there are many ABA centers who have therapy program supervisors that are neither a BCBA, nor a BCBA in training. By making sure your child’s program supervisor is at least a working towards their BCBA, and supervised by a BCBA, you are ensuring that your child’s program will be overseen by someone who is qualified, competent, and knowledgeable in ABA. You don’t want to have your child’s program overseen by someone who has haphazardly fallen into their role as a behavior analyst.

Safety training

Safety, safety, and more safety! ABA centers MUST master safety. With such a large volume of children who must be supervised constantly, it is crucial that the ABA center is vigilant at all times when it comes to safety protocols and procedures.
One of the best ways to check if safety is being maintained at a center is to ask about the training of the staff, beyond ABA skills.
Are the staff CPR trained and First Aid certified? Not having staff that are CPR and First Aid trained poses a great risk. There may come the time when a child’s life is in danger and requires CPR, medical attention, or care for an injury.
Another question to ask: are the staff trained in crisis management? Crisis management is a set of techniques and strategies developed to minimize violent incidents and escalating crises. Children with special needs may often engage in challenging behaviors and create potentially dangerous situations. Having the right tools to safely manage these types of risks is crucial for any ABA center.
Another important question: Does the center have appropriate safety protocols throughout the center that staff are trained on? Does the center have dialed-in procedures for lock-downs, tornado drills, and fire drills? Just like at a school, an ABA center needs to have all these procedures and more in place to be truly safe for your child.
Another way to measure the safety of an ABA center is through looking at their security mechanisms and child-proofing. Does the center have effective security mechanisms on entries and exits to prevent children from eloping? Does the center have their drawers and cabinets adequately child-proofed so that children can’t access harmful cleaning chemicals? If they have a kitchen, is there a locked drawer for items that could be sharp?

Do they background check the staff?

Any company that is working closely with children should be background checking their staff. If it concerns you as a parent that some centers do not background check their staff, then your head is in the right place!
Gain the peace of mind of knowing that the ABA center you send your child to is doing background checks. Simply ask and find out for yourself.