Navigating insurance coverage for Autism Spectrum Disorders (ASD)
Florida enacted autism insurance reform on May 2, 2008, under the Steven Geller Autism Coverage Act. As a result, large group health insurance plans and HMO large group health plans provide coverage for diagnostic screening, intervention and treatment of ASD. However, coverage for ASD is not required by state law for small employer (50 or less employees) group plans or self-insured plans.
HOW DO I VERIFY WHETHER I HAVE ASD COVERAGE?
To verify whether your policy covers treatment for Autism, check your policy booklet under the terms “Applied Behavior Therapy,” “ABA Therapy” or “Autism Therapy.” If access to your policy booklet is not readily available, contact your insurance plan directly using the telephone number listed on the front (or back) of your insurance card. If you verify by telephone, make sure you keep a record of the reference number for the call, and the name of the representative you spoke with.
INSURANCE & CBG
After you have completed the new client paperwork, our billing department will take care of the insurance process. CBG will contact your child’s insurance company to verify benefits for ABA therapy. The billing department will compose an explanation of benefits and parameters of payment document detailing the cost for ABA therapy services.
Benefits will vary depending on the employer group plan. HMO plans generally have a copayment per day with a designated out-of-pocket maximum amount. Most PPO plans utilize a deductible which must be satisfied; afterwards, the plan will cover 80 percent of the allowed charges while you cover the other 20 percent. As with the HMO plans, the PPO policies have a maximum out-of-pocket amount that must be satisfied. With both policy types, once the out-of-pocket maximum has been satisfied, the insurance company will cover 100 percent of the allowed charges.
Cayer Behavioral Group’s billing procedure is as follows:
services are provided by your child’s therapist(s);
the following week, the services are submitted to the billing department for submission to the insurance company;
the claims are submitted electronically through the individual insurance carriers clearinghouse (or website);
your insurance plan generally remits payment within 10 business days; and,
CBG will send you an invoice for the copayment or deductible amount due on the 10th and 25th of each month.
Contact Cayer Behavioral Group today to let us help you find your new normal!