Navigating the Insurance Process:

Learn how with HLG

Navigating the insurance process can be a daunting task. Don’t do it alone! We have the tools and the know-how to get you answers fast. Whether your coverage is local or out-of-state, our staff will verify your eligibility for ABA benefits in a timely manner and get you off and rolling as soon as possible.

Read the most frequently asked questions regarding insurance coverage:

How can I determine if my child is covered for ABA services?

Coverage for ABA benefits is determined by how your particular plan is funded. Fully-funded insurance plans are required, by law, to cover ABA services. Self-funded plans determine their own coverages and do not have to allow funding for ABA services.

But how do you know if your plan is fully-funded or self-funded? You can call your insurance company and get specific benefit an eligibility or simply let us do the heavy lifting.

We are extremely well-versed in determining benefits and eligibility with accuracy and in a timely manner. We are happy to navigate the twists and turns of the insurance maze. To have us determine whether you are eligible for ABA services through your insurance plan, click here.

Will my child be covered if he/she does not have a diagnosis of autism?

Benefits granted under the ABA insurance mandate are only valid for individuals with diagnosed with an autism spectrum disorder. Diagnoses other than autism spectrum disorders are NOT covered under the insurance mandate.

Insurance carriers require a diagnosis of an autism spectrum disorder from a physician or doctorate-level clinician. The insurance carrier often requires a letter of medical necessity for ABA therapy.

How long does the insurance company take to verify benefits?

The length of time it takes to verify whether a member has or does not have coverage varies by insurance companies. Some insurance companies can provide benefits and eligibility the same day. Others may take 1-3 business days to confirm or deny the ABA benefit. The silver lining in this cloud is that we do all the calling for you. We will make the initial call and all follow-up calls as needed. We work hard to verify benefits as soon as possible because we do understand that time matters.

Can you review the insurance process, step by step, from intake to service?

Here is a quick overview of the intake process for those with insurance coverage:

  1. Contact us and complete the insurance intake form.
  2. Provide HLG with a copy of the evaluation report granting the diagnosis of an ASD.

    *A letter of medical necessity may also be needed*

  3. HLG will contact the insurance company to verify benefits.
  4. If benefits are verified, HLG will contact the insurance company to obtain authorization for an initial intake.
  5. HLG conducts the intake and submit intake documents to the insurance company in order to obtain ongoing authorization.
  6. Once ongoing authorization is obtained, ongoing therapy begins.

The total timeline varied based on response and timeliness from your family and from the insurance company. We work hard to ensure the insurance company responds to our requests as soon as possible.

Give us a call and see how we can help you today!

Will I be responsible for any payments if my insurance covers ABA?

As with any other procedures covered by your insurance plan, you are fully responsible for your deductible, if any, and the entirety of co-pays or co-insurance.

Any charges billed for ABA services will count towards your deductible, if you are subject to one and the limit has not been met. After the deductible is met, families are charged one co-pay per day until the maximum out-of-pocket expense is met, if applicable. Therefore, whether a therapist is in the home for one hour or three hours or there are multiple clinicians in the home on the same day, you are only liable for one co-pay for that date of service. For families that have a co-insurance, the co-insurance will be applied to each procedure and charge incurred for any and all dates of service.

HLG bills families on a monthly basis for all charges incurred.

What do I do if my insurance plan does not cover ABA benefits?

Unfortunately, the options to obtain coverage for ABA benefits are limited. Self-funded plans, which routinely deny ABA coverage, are able to set optional coverages as they see fit. Some families have lobbied their employer’s human resources department to either make an exception on their behalf or opt in to the ABA coverage benefit with success. However, please note that these successes are far and few between.

Another option is to privately pay for ABA services.

Give us a call and we would be happy to speak with you about any options available.

We are insurance experts! Give us a call and let us do the work for you!

We are in-network providers with:

Aetna
Amerihealth
Blue Cross and Blue Shield
Horizon BCBS
Magellan
Oasis
Premera Blue Cross
Tricare/Healthnet
ValueOptions
Qualcare

**Note: We are able to work with any insurance company that allows for the ABA benefit.

Click Here to Get Started

Click here to read the official NJ ABA mandate bulletin here.

Why Should You Choose HLG?

The HLG Difference

We know there are a number of providers who offer ABA services and the task of choosing the right one can be daunting. After all, when it comes to educating and supporting your child, every parent wants the absolute best.

At HLG, we pride ourselves on having well-rounded, expert board certified behavior analysts (BCBAs) that supervise and coordinate all programs. Under the direction of our clinical director, May Beaubrun, our BCBAs stay up-to-date with the latest research outcomes so we remain at the cutting edge of any advances in the field. Our behavior technicians, who directly carry out programming, receive ongoing training from our supervision staff so the information disseminated  can be applied quickly and effectively. All staff members undergo regular supervision checks and must maintain a predetermined level of performance to continue working with our learners.

But the biggest difference that sets HLG apart is our ability to listen to you as a parent. While we are the experts behind the science of behavior, you are the expert on your child. We rely on you, as a parent, to be a collaborative member of the team. We want your feedback regarding goals, programming and progress. Our approach is not to walk into your home with an immediate list of dos and don’ts. Rather, we want to observe your routine and figure out how to help seamlessly integrate ABA-based principles into what already happens in the home. We believe parents are more apt to “buy-in” to a program that does not flip their livelihood upside down unnecessarily.

woman and toddler playing with wooden construction game

Give us a call and ask to speak to families with whom we currently work. There is no better advice than that given from a fellow parent.

Click here to get started.

The HLG Difference

School districts, like individual families, only want the best for their learners. The difficult aspect to working in a school setting is the amount of confounding variables across a school day. At HLG, we understand the uniqueness of working with learners with special needs in a school setting. Whether it be in a special education classroom or a general education classroom, our BCBAs and consultants are experienced helping educators get the most out of their learners.

The difference that HLG brings is that our school district BCBAs were all former teachers. They know the nuances of a classroom. They know how to get the most out of a little. Our school district BCBAs are efficient, effective and knowledgeable. What you won’t get is a consultant who disregards a teacher’s natural talents and efforts. We work with the educators to enhance their strengths and develop an areas of deficit. We work extremely hard to seamlessly integrate ABA practices and principles into an educator’s standing routine. But, if a routine needs to be modified, it is done on a collaborative basis.

Teacher

Pair these efforts with years of experience working in the classroom and you have a formula for success!

To find out more about school services, click here.