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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

2014Louisville

Panel: Challenges to Families and Providers in Obtaining Payment for Services

 

 

 

 

 

 

 

 

 

Abstract: Children with autism often have co-occurring behavioral health disorders, such as feeding disorders (70%), aggression (26%), or self-injurious behavior (19%). Insurance companies often attribute these co-occurring disorders to the individual’s autistic disorder, a problem referred to as diagnostic overshadowing, and then use this attribution to deny payment for treatment. The panel discussion will include a process that has been used to preauthorize patients for day-treatment feeding and severe behavior programs. Nearly 80% of all initial treatment requests are denied by insurance companies and thus must be appealed by the service provider. Often, it is necessary to have the family ask human resources personnel to contact the insurance provider as a part of the appeal process. In addition, claim follow-up is an essential component of the process to ensure that full negotiated payment is received for the services provided. Documentation and perseverance are perhaps the most critical elements in obtaining an authorization for a client to begin services. Using these procedures, the Munroe-Meyer Institute has obtained prior authorization and payment for about 90% of the patients for whom it makes initial requests.

 

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