Insurance Services Description & Rate Sheet

AUTISM AND ABA SERVICES: Insurance is billed for ABA services only after an authorization has been secured for the child.

Note: The people who issue authorizations clearly state that services are not guaranteed for payment when authorization is secured. If services provided are rejected by the insurance company, then the family will be billed if the insurance carrier will not reverse their payment decision.

The insurance companies put the following parameters on BCBA services that cannot be avoided by us:

1. Patients are responsible for their own co-pays, coinsurance and deductibles to the provider.

2. 1 hour of BCBA time is allowed per 10 hours of Behavior Therapist (aka “Line therapy”) per week

5 hours per week 2 BCBA hours per month
10 hours per week 4 BCBA hours per month
15 hours per week 6 BCBA hours per month
20 hours per week 8 BCBA hours per month
25 hours per week 10 BCBA hours per month

3. BCN requires that no more than 3 hours per week are delivered by a BCBA within a rolling 7-day week. In addition, no more than 25 hours per week can be delivered by the behavior therapist in this rolling 7-day week.

4. BCBS and other insurance companies require that no more than 3 hours are delivered within a 7-day calendar week of Sunday through Saturday. In addition, no more than 25 hours per week can be delivered by the behavioral therapist in this rolling 7-day week.

5. Parent consultations / training are allowed where relevant to the child’s ABA treatment program

6. IEP meetings or meetings with other service providers are not covered.

Miscellaneous Fees

1. Cancelled or returned check fee – $25 + amount owed
2. BCBA or Behavioral Therapist NCNS session – $25 per session, per day
   (family failed to notify that the session was cancelled and we traveled to the session)
3. Short notice cancellation – $25 per session, per day