So, several days ago, I said that step 1 is to find a behavior analyst. Let’s talk about what else you need to do.

Step 2: All hands on deck. Now, you’ve found a behavior analyst, you’re researching ABA and Verbal Behavior. You know this is what you’re child needs – here’s the big question – How do we pay for it? It’s time to solicit some help. Assemble the following:

A prescription for ABA from your doctor

A summary of relevant research about ABA’s effects

A copy of your assessment, behavior program, or other program materials from you ABA provider

Your insurance contact information

Here are some details:

Letter and Prescription from you Doctor – a primary care physician or a specialist who diagnosed your child are great people to help. You should have a prescription for behavior analysis services. Ask for specifics, like recommended number of hours per week. We’ve had kids with something like ’40+ hours per week of intensive Applied Behavior Analysis at an Early Intervention Clinic until at least the 5th birthday’
Having this documented as your physician’s recommendation is very helpful. Your ABA provider can submit this with their assessment and recommendation to your insurance company, state agencies, etc.

Now that your physician has done their part, your behavior analyst needs to do the same. A BRIEF summary of successful published research, the agencies personal results, and clarification of the services to be provided can be helpful in allowing the potential funding source to understand what is being requested. Remember, there are a whole lot of people out there who still don’t know about ABA. They want to be sure that if money is going to a treatment, it’s legitimate and warranted. Your documents should provide clear, concise information about ABA, its expected outcomes, and why it is absolutely necessary that your child receive it and receive it now. Documents should always be professional and polite, but firm.

Assessment: Your behavior analyst should have conducted an assessment, and should have a recommendation for service as well as program goals. If you’ve already been receiving service, then a progress summary is also very helpful.

Now it’s time to call your insurance company, probably with your behavior provider, and all the ammo you’d like to try.

You may get pre-authorization for service, or you may leave the call empty-handed. Don’t give up! Try sending a claim for service received, it just may get paid. Try fundraising to off-set your out of pocket costs.

Family, friends, and even strangers may be sympathetic to your struggle. Don’t let me be a pessimist, sometimes, a family has great insurance, or a pre-established program for funding, or a school system that is willing to cover their ABA expenses, or a full-scholarship. We have half a dozen clients right now who we NEVER have to say a word about money to. However, we have far more clients who funding is the overriding topic of our every interaction. If you can afford to pay out-of-pocket for service, that’s great! There is no better investment. If you can’t, though, it’s time to get creative. We have a couple moms (and dads) who are true superstars with this, and their efforts are commendable, impressive, and downright amazing. They do bake sales, movie nights, picnics, and a whole host of other undertakings to raise funds for their child’s therapy.

The overall lesson to take from Step 2 is: You’re going to be busy if funding therapy is your goal. Sit down with your behavior analyst and call your insurance company to try to get pre-authorization for service. If you are unable to get a pre-authorization, ask your behavior analyst to submit the claim as an out of network provider. They may get rejected, but you may get reimbursed by your insurer, as some of our clients have. It never hurts to try.