The New Year brings hope, resolutions, and, in some cases, insurance changes. Employers reevaluate their plans, insurance companies tweak their policies, and deductibles reset. Big or small, these changes have an effect on your ABA journey, so let’s look at some ways to make the insurance transition work for you!

Is your provider still in-network?

The biggest and most important change to look out for is a change in your insurance’s in-network providers. While some insurances allow you to see out-of-network providers, this often comes with a much higher price tag so it is important to make sure that you are stillInsurance able to see your current providers.

Insurance websites often have easy-to-use search tools to find which providers are in-network. You can also call your provider directly. They should be able to quickly tell you if they are still able to take your insurance.

If your ABA provider is no longer able to accept your insurance, they are ethically obligated to provide you options of other providers in the area. 

Same plan, new policies

Insurance providers can change their rules on how much ABA therapy they will cover. In addition, insurance companies don’t always see eye to eye with a BCBA’s recommendation of hours. This can be extremely frustrating for all parties involved because what we want is the best for your child. 

In the case that your insurance approves less hours than recommended, we suggest leaning on your ABA provider. Like we said, we are here to give your child the services they need. It may take time, but the reports we file with the insurance companies can show that more therapy is needed. So advocate with your ABA provider and work together to get the hours your child needs!

More out-of-pocket expenses

The new year often means starting over with your deductible. No one likes it, but it is an unfortunate part of our insurance system. So what can you do? Really, the best advice is to know it’s coming and try to make a plan for it. A few cuts here and there can really help until you’ve met your deductible. 

If you are having trouble paying for all of it, pay for as much as you can, save receipts, and send them to your insurer. This offers proof to them that you are doing what you can. They can’t keep track of something they can’t see. But if they can see it, they are usually more likely to work with you on a long-term plan.

Insurance changes are never fun and can be really stressful. If you have more questions or concerns, give us a call, and we would be happy to talk with you!

Click here for insurance FAQ’s

We have been a family blessed with the help of the team at The Helm. Our son was diagnosed with autism spectrum disorder when he was 2.5 and The Helm was one of the places recommended by our developmental psychologist. I am a physician and still found it hard navigating this new medical problem and knowing what to do next. I called many places and from step one Lee Ann was the most helpful explaining the process with paperwork, assessment, available services, insurance, etc. we were able to start therapy quite soon after diagnosis and had sessions at home daily for 3 hours. The quality of staff, the system they have in place for the therapists, the coordination by the BCBA supervising therapist and early response put us at ease that we were on the right path. Ultimately the steady positive changes we saw with our son overcame any fears we had about autism holding our son back for the rest of his life.

We used many forms of intervention that we felt were individually tailored for our family – for potty training, anger management, dietary intervention and even let them know when we could not maintain something suggested in family training, and they would just take our request and implement another plan. Our son has now graduated/transitioned out of therapy and is currently in pre-K in a regular classroom with him on par with his class in academics, has friends and no behavior issues. Most important of all we have a happy son who loves to play with his big sister.

I know that I will always read all there is on autism and watch my son for any features. But I hope my review adds to positive aspects that I wish someone would have told me when I started the journey – start early, don’t put off your suspicions, get your child evaluated now! The label does not hinder,  in fact it falls to the side once you have the diagnosis to facilitate therapy. ABA intervention, especially done with the right people, makes a big difference. It does not pressure or upset the child at all, and you are not stuck in therapy for life! I know if any behavioral issues come up in the future I have The Helm, and they will help us and the outcome is going to be positive. Said with heartfelt thanks.

– Former Helm ABA Family

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