Health Insurance is tricky to understand and securing ABA services for a loved through health insurance can often seem insurmountable.  NCR Behavior Services has a tremendous amount of experience working with insurance plans across the country to secure authorizations for ABA services.  This blog will provide you with information regarding the legal obligations of insurance companies in the state of Nevada and information about how NCR can help you secure an authorization of service..

What must be covered?  A health benefit plan must provide coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders to persons covered by the policy of group health insurance under the age of 18 years or, if enrolled in high school, until the person reaches the age of 22 years.

What does this mean? Your loved one is eligible to receive a screening, diagnosis, and treatment (if they are diagnosed with autism) as long as they are under the age of 18 (or under the age of 22 if they're enrolled in high school).

How much must be covered? (a) A maximum benefit of the actuarial equivalent of $72,000 per year for applied behavior analysis treatment; and

(b) Copayment, deductible and coinsurance provisions and any other general exclusion or limitation of a policy of group health insurance to the same extent as other medical services or prescription drugs covered by the policy.

What does this mean?  Your loved one's insurance company is responsible for funding their ABA treatment for the amount of $72,000 maximum per year.  This also means that you or your loved one cannot be asked to pay a larger copayment, deductible, or coinsurance than what you/they already pay for medical care.

Types of Coverage NCR Accepts

NCR currently serves patients with commercial health insurance plans who provide the following types of coverage:

Out of Network Coverage:  Typically a benefit found under PPO plans, this allows your loved one to be seen by an out of network provider.  NCR Behavior Services handles all of the necessary paper work, authorization, and billing for this process.

Single Case Agreement Coverage:  Typically a benefit found under HMO or EPO plans, this allows your loved one to be seen by an out of network provider under the same financial circumstances as an in network provider.  In this situation, NCR Behavior Services takes the necessary steps to contact your insurance, request a Single Case Agreement and provide the substantiating information to obtain the agreement. 

Private Pay Coverage:  Private pay coverage is exactly what it sounds like.  Services are provided to your loved one and then the payor is billed directly.  This may be you, the learner (if of age), or another stakeholder.  The terms of this agreement are reviewed in depth and a private pay agreement is provided with a significantly discounted rate.

ATAP:  Stay tuned as we work through the process to become approved by ATAP.

Please don't hesitate to contact NCR Behavior Services with any questions regarding the insurance and funding process.  We are here to help!