Questions to ask your insurance about ABA
Use these questions when you call your insurance or Medicaid plan about ABA therapy. They help you find out whether ABA is covered on your child's plan, what is needed before it starts, which in-network providers are near you and what you may pay. Print the list and write down each answer, the date and the name of the person you spoke with.
What should I have ready before I call my plan?
- Your insurance or Medicaid card with the member ID.
- Your child's date of birth and your zip code.
- Your child's diagnosis report, the date on it and the name of the clinician who wrote it.
- The names of any ABA providers you are already talking to.
- Your ABA waitlist tracker and a pen.
What should I ask my insurance about ABA coverage?
- Is ABA therapy a covered benefit on my child's plan?
- Is prior authorization needed, and who sends the request: us or the provider?
- Does ABA need a referral, or a diagnosis from a specific type of clinician, before it can start?
- Which in-network ABA providers are near our zip code? Can you send us the list?
- Are there limits on hours, visits or age for ABA on this plan?
- What will we pay: a copay, coinsurance or a deductible first?
- Are parent training sessions covered too?
- Is there a case manager or care coordinator who can help us find a provider with openings?
Who do I call about ABA coverage?
Call the member services number on your insurance card. If your child has Medicaid, call the member services line for your child's Medicaid plan. Write down the date, the name of the person you spoke with and the call reference number, so you can point back to the call later.
What should I ask if my child has Medicaid?
Ask the same questions, plus how your plan handles ABA for children under the EPSDT benefit, whether your child can have a care coordinator, and which ABA providers near you take your child's Medicaid plan. Our guide on how to know if ABA is covered has more on Medicaid.
What should I ask if we have Tricare?
Ask how referrals and authorization for ABA work for your child, which authorized ABA providers are near you, and what paperwork you need to send first. Tricare's own program page for military families is listed in the sources of our guide on how to get ABA therapy faster.
What if no in-network provider has openings?
Ask your plan about out-of-network options and whether a single-case agreement is possible with a provider who can see your child sooner. A case manager can often help with both. Keep calling providers in the meantime with our ABA provider call script.
What should I write down after the call with my plan?
Write down the date and time, the name of the person you spoke with, the call reference number, the answer to each question and anything you need to send next. If you hear something important, such as whether prior authorization is needed, ask whether the plan can confirm it in writing.
How do I use these questions?
- Print the question list, or keep it open on your phone.
- Have your member ID, your child's date of birth and the diagnosis report ready.
- Call member services and ask the coverage questions in order.
- Write each answer down with the date, the person's name and the call reference number.
- Call the in-network providers on your list with the ABA provider call script, and log each one in your waitlist tracker.
Is the question list free?
Yes. Print it, copy it or read it from your phone. Nothing you write on it is sent to Waitless.
See which providers have openings now and how long waits are for your insurance.
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