Therapy questions
What is ABA therapy, and how does it benefit children with autism?
ABA therapy, or Applied Behavior Analysis, is a scientifically validated approach that focuses on understanding behaviors and breaking them down into small, doable steps. For children with autism spectrum disorder (ASD), ABA therapy can help them learn and apply new skills, reduce challenging behaviors, and improve communication and social interaction.
How do I get started with ABA therapy for my child?
Getting started is easy! Simply enroll here or give us a call to schedule an initial consultation. During the consultation, we’ll discuss your child’s needs, goals, and preferences, and develop a customized plan of care tailored to your family’s unique circumstances.
What ages do you work with?
We provide ABA therapy services for children of all ages, from toddlers to teenagers. The exact age range varies according to insurance policies.
As children with ASD often develop at their own pace, our individualized approach ensures that each child receives therapy tailored to their unique needs and developmental level, regardless of their age.
Where do sessions take place?
Our ABA therapy sessions primarily take place in your child’s home, where they feel most comfortable. This way, learning opportunities come more naturally and your child learns to apply their new skills throughout their day.
How do you measure progress?
We use a combination of standardized assessments, direct observation, and data collection methods to measure progress and track outcomes. We regularly review and discuss your child’s progress with you, and make adjustments to treatment plans to ensure continued growth and success.
Insurance questions
Is ABA therapy actually covered by my insurance?
In most cases, yes. Most private insurance plans and Medicaid are now required by state or federal law to cover ABA therapy when it is "medically necessary." However, coverage is almost always contingent on your child having a formal diagnosis of Autism Spectrum Disorder (ASD) from a licensed professional (like a neurologist or psychologist).
What are "Deductibles," "Co-pays," and "Out-of-Pocket Maximums"?
These terms determine what you will actually pay each month.
Deductible: The amount you pay out-of-pocket for healthcare services before your insurance begins to pay.
Co-pay: A fixed dollar amount (e.g., $25) you pay for each therapy session.
Coinsurance: A percentage (e.g., 20%) of the total cost you pay after your deductible is met.
Out-of-Pocket Maximum: The "finish line." Once you spend this amount in a calendar year, your insurance typically covers 100% of the remaining costs for the year.
What is "Prior Authorization," and why does it take so long?
Before starting therapy, your insurance company must "authorize" or approve the treatment. This is their way of verifying that the therapy is necessary.
The Process: We submit your child’s diagnosis and a proposed treatment plan to the insurance company.
The Wait: It typically takes 2 to 4 weeks for them to review the paperwork and give the green light. We cannot bill insurance for therapy sessions until this approval is received.
Do I need a new referral every few months?
Usually, re-authorization is required every 6 months. Insurance companies want to see progress to continue paying for services. Your Board Certified Behavior Analyst (BCBA) will write a progress report showing the goals your child has met. We handle the paperwork, but we may occasionally need you to provide an updated prescription or "Letter of Medical Necessity" from your pediatrician.
What is the difference between In-Network and Out-of-Network?
In-Network: We have a contract with your insurance company to accept a specific rate. This usually results in much lower costs for you.
Out-of-Network: We do not have a contract with that company. You might have to pay the full price upfront, or your insurance may only cover a small portion (or none at all).
Pro-Tip: If there are no in-network providers in your area, you can sometimes request a Single Case Agreement (SCA), which asks the insurance company to treat us as an in-network provider for your child specifically.
