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[quote=Anonymous]Many insurance companies will authorize, at minimum, an ABA initial assessment by a BCBA with just a Rx assessment from a pediatrician or a pre-diagnosis that fits one of their pre-determined categories. Also if you’ve been utilizing ABA and change insurance providers usually they continue it, at least for several months, until you meet their additional requirements.

Often insurance, at least initially, will only authorize the initial assessment and wait for the ABA provider to send copies of assessments, assessment report, goals and objectives, and recommendation for service hours. Some companies then require the pediatrician to write another Rx for hours based upon the findings of the initial ABA assessment others will approve X hours for Y weeks based solely on BCBA recommendations.

The reason they’re pretty lenient initially, especially with EI, is many young  children aren’t testable by standard means. You might have an 18 month old with pediatrician flagging possible developmental disabilities, but they are unable to attend to standard testing.  In that instance the presence of barriers to learning/testing is enough to warrant a need for ABA without a formal diagnosis of X.

When you go for reevaluation they’ll want to see that child  has made progress so you ideally repeat the same assessments, write another report, and make new recommendations. Usually at that point they’ll renew services again without much question as long as progress is being made and parents still want services. Some require another Rx from pediatrician following the reassessment. It’s very company/provider/plan/state dependent, some are very particular and some are more lenient.

After about another year of ABA though, this child should have enough skills to be testable or at least diagnosable and insurance might then start asking about an ADOS and/or more formal diagnosis from pediatrician. They usually give time for this, like ok we’ll approve hours for another 9 months but you need to get x, y,z before their next birthday. At some point they want diagnostic evals to justify continued services. Especially after about 2-3 consecutive years of ABA. 
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