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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Are you wanting to pay with insurance or can you afford self-pay?[/quote]

I’m fine paying for it with insurance. What’s raising little red flags for me is that these ABA providers all ask about insurance within literally five seconds of picking up the phone. And without even reading an evaluation describing my child, they’re “requiring” at least 15 hours per week.  Are they milking the insurers even if it’s not necessary?

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No they aren’t milking the insurance, it’s more like the other way around. Unfortunately the insurance system broke the field of ABA almost immediately from the perspective of affordable service delivery. It stinks too because the parents that fought so hard to get it really cared and were doing the right thing but almost immediately insurance became nothing but a hassle for the provider. I’ll never forget writing an insurance report many years ago that took 25 hours, I could’ve done a different - and better- type of report that might have taken 5 hours but their requirements were so exact that it took 5 times longer.

So the reason the provider asks immediately about insurance is because the provider may not accept your insurance, different insurance companies have different requirements for diagnostics and BCBA/RBT hours, intake, assessments, etc. I would not write these providers off for asking about insurance, I’d just give them grace and try to understand that insurance often dictates how they work. I’d actually worry if this wasn’t a first question they asked you because it determines their next steps.

Regarding hours I’ve not seen any insurance except TRICARE cover BCBA only for 5 hours per week. You can fairly easily get this for that age if you’re private pay. You also might be able to pay up front and submit reimbursement to your insurance, you used to be able to do that with some insurance companies. (I’m not sure how it works now I haven’t accepted insurance in years because it got to the point where insurance company regulations were going against my standards for best practice so I dropped them completely.)

From a clinical perspective 5 hours per week for that age is probably doable, it’s what you’d call a consultative role where more focus is on parent training and maybe a few key skills/behaviors. But you do need a higher level of skill/experience to pull it off imo. Check the website as suggested above  for BCBA’s or find a company that’s BCBA only and ask about a weekly consult via private pay. The BACB website provides you with initial date of certification, look for people that have been certified awhile, they’re more likely to take a case like this, I would think. I also think once you tell  them you are private pay they will probably be able to work more with your individual needs.

*opinions are my own, don’t represent the BACB[/quote]

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