Behind The Scenes: Initial Assessment & Ongoing Authorization Request
As mentioned in our previous blog post, we aim to be transparent regarding what occurs in regards to obtaining authorizations for services from your insurance company. The following outlines the initial assessment process as well as the procedure for requesting and obtaining the authorization for ongoing ABA therapy services.
Once we have received the authorization, your BCBA will reach out to schedule the initial assessment. Most insurance companies approve between 8 and 12 hours for the initial assessment. These hours include both the time that the BCBA will spend working with your family in person as well as the hours that they will spend writing up the report off-site.
When your BCBA calls you to schedule the assessment, they may ask a few general questions. They might ask you to tell them about your child or could ask why you are seeking services. This information will help the BCBA to decide which assessment tool will be the most beneficial to run once they begin the assessment in your home. Insurance companies require that a standardized or curricular assessment is run at the initial assessment and at each subsequent assessment.
When meeting with you to complete the assessment, the BCBA may have you complete questionnaires regarding your child’s strengths and weaknesses as well as their behavior. They may use a formal questionnaire to gather needed information or may informally ask
questions regarding certain skills. Likely, a combination of both will occur. The BCBA will likely spend some time completing an observation, making note of your child’s abilities, deficits, and behaviors that occur during that time. They will also probe skills to help determine your child’s abilities. Your priorities, along with the BCBA’s observations, will be used to determine your child’s ABA therapy goals. The BCBA will also complete a Functional Behavior Assessment (FBA) for any challenging behaviors that should be reduced. These include behaviors that are injurious to the child or other individuals or behaviors that interfere with the child’s daily life. The BCBA may collect baseline data to determine your child’s starting point for their goals and to help determine next steps. With your consent, they may also reach out to other providers involved in your child’s care to collaborate and ensure consistency across interventions.
Once the BCBA has gathered a sufficient amount of information, they will write your child’s treatment plan. The treatment plan outlines your child’s strengths as well as areas in which they could use additional instruction and support and includes the specific goals put in place for your child. To address any challenging behaviors, the treatment plan will include a Behavior Intervention Plan (BIP), which outlines proactive and reactive strategies that will help to decrease the behavior. The BCBA will complete the written report within two weeks of meeting with your family.
Initial Assessment Submission & Ongoing Authorization Request:
Once the treatment plan is complete, it will be submitted to your insurance company for approval. Most insurance companies require the treatment plan to be faxed or emailed to their ABA department for review. For some insurance companies, a phone review is required in order to get the approval for ongoing services. Most insurance companies have approximately a two-week turnaround time for authorizations after submission. The authorization will include the service codes for ABA that are approved (ABA therapy with a Behavior Tech, BCBA Program Modification, Caregiver Training, and Reassessment) along with the number of hours that are approved for each service.
Once the company has received your child’s ongoing authorization, we will notify the BCBA and Behavior Tech. They will coordinate with you to begin ongoing therapy sessions.