Insurance Information


INSURANCE FREQUENTLY ASKED QUESTIONS

Deductibles? Co-Pays? Out of Pocket Maximum? Insurance can be confusing. Our Team is here to help you understand your ABA coverage and the process to claim benefits. You are not alone. Our Team is prepared to help our families navigate insurance coverage for autism therapies. Please feel free to contact our Clinical Manager Meghan Jones (emjones@goodshepherdcs.org ) for assistance.


Step 1: Verify Benefits

Our Team needs the completed Insurance Reimbursement Form which includes::

  • Copy of current insurance card (front and back)
  • Policy holder’s first and last name
  • Child’s first and last name
  • Child’s date of birth
  • A current address
  • Current phone number

Our Team will contact your insurance carrier to find out if you have coverage for ABA services. This process can take 5-7 business days.  A team member will contact you with the answer.

Step 2: Authorize an Assessment

If you do have ABA benefits and you would like to use your insurance to pay for services, Our Team needs to authorize an assessment. Our Team needs the following information.

  • Proof of Diagnosis*
  • Prescription for ABA services written AND signed by a Physician, Pediatrician, etc. (anyone with a M.D. or Ph.D.)

*The diagnosis letter should be dated 2015 or after with new coding (F84.xx instead of 299.xx).

Our Team will then call the insurance company back. The insurance company will give us permission to start an assessment with your child. We can not start services until we have authorization.

Step 3 : The Assessment

You will need to schedule the Assessment with our Clinical Manager.  The Assessment can take up to 8 hours. Sessions are typically scheduled in 2 hour blocks. Your child will work 1:1 with a BCBA (Board Certified Behavior Analyst) until the Assessment is complete.

Step 4: Authorize On-Going Services

When the Assessment is complete, a BCBA will schedule a time to meet with you to review your child’s Assessment and discuss your child’s treatment plan. The Team will recommend the number of hours we think will benefit your child the most. Our Team will submit the Assessment to your insurance company and a request for on-going services. Once we have received an authorization, we will begin services. Your child will work 1:1 with a Behavior Technician Your child will receive supervision of their program by a BCBA.

Step 5: Six Months Later

Every six months, insurance companies require an updated Assessment. Our Team needs the following information:

  • NEW prescription for ABA services written AND signed by a Physician, Pediatrician, etc. (anyone with a M.D. or Ph.D.)
  • Our Team does NOT need a new Proof of Diagnosis

Our Team will then call the insurance company back. The insurance company will give us permission to start an assessment with your child. We cannot start services until we have an authorization.

You will need to schedule the Assessment with our Clinical Manager. The Assessment can take up to 8 hours. Sessions are typically scheduled in 2 hour blocks. Your child will work 1:1 with a BCBA (Board Certified Behavior Analyst) until the Assessment is complete.