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May 2025 bring you a world of new beginnings! Happy New Year 🎉🥂🍾
01/01/2025

May 2025 bring you a world of new beginnings! Happy New Year 🎉🥂🍾

Welcome October! May everything you touch FALL into place for you!! 🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂
01/10/2024

Welcome October! May everything you touch FALL into place for you!! 🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂🍁🍂

Here’s an explanation of “fee-for-service” applied to ABA:Fee-for-service is a payment model where ABA providers are pai...
18/09/2024

Here’s an explanation of “fee-for-service” applied to ABA:

Fee-for-service is a payment model where ABA providers are paid separately for each service or session they provide, rather than receiving a fixed salary or bundled payment. Under this model, every ABA therapy session, assessment, or consultation is billed individually, and you or your insurance company are charged based on the specific services rendered.

For example, if your child attends an ABA therapy session, the provider charges a fee for that specific session. If additional services such as an assessment or a parent consultation are provided, each of these services would be billed separately under the fee-for-service model. This model allows for detailed billing, but it can also lead to higher overall costs if multiple services are provided.

Fee-for-service models are common in ABA, particularly when providers work with insurance companies to ensure that every aspect of care is covered and appropriately reimbursed.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “EPO” applied to ABA:An EPO (Exclusive Provider Organization) is a type of health insurance pla...
17/09/2024

Here’s an explanation of “EPO” applied to ABA:

An EPO (Exclusive Provider Organization) is a type of health insurance plan that requires you to use a network of specific providers, including ABA therapists, to receive coverage. Unlike a PPO, an EPO does not cover out-of-network care except in emergencies, meaning you must use in-network ABA providers to have your therapy services covered.

For example, if your child requires ABA therapy and you have an EPO plan, you must choose an ABA provider within the EPO network. If you decide to see a provider outside of this network, your insurance will not cover the costs, and you would be responsible for the full amount.

EPO plans often have lower premiums than PPOs but come with less flexibility in choosing providers.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “PPO” applied to ABA:A PPO (Preferred Provider Organization) is a type of health insurance plan...
16/09/2024

Here’s an explanation of “PPO” applied to ABA:

A PPO (Preferred Provider Organization) is a type of health insurance plan that offers more flexibility in choosing healthcare providers, including ABA therapists. With a PPO, you can see both in-network and out-of-network providers without a referral, though staying within the network usually means lower out-of-pocket costs.

For example, if your child needs ABA therapy and you have a PPO plan, you can choose any ABA provider, whether they are in-network or out-of-network. If you select an in-network provider, your insurance will cover a higher percentage of the costs, resulting in lower expenses for you. If you choose an out-of-network provider, your insurance may still cover some of the costs, but you’ll likely pay more out of pocket.

PPO plans generally have higher premiums than HMOs, but they offer greater flexibility in provider choice.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “HMO” applied to ABA:An HMO (Health Maintenance Organization) is a type of health insurance pla...
15/09/2024

Here’s an explanation of “HMO” applied to ABA:

An HMO (Health Maintenance Organization) is a type of health insurance plan that requires members to receive healthcare services, including ABA therapy, from a network of approved providers. To access ABA therapy under an HMO plan, you typically need a referral from your primary care physician (P*P) and must use ABA providers who are part of the HMO network.

For example, if your child needs ABA therapy and you have an HMO plan, you’ll need to see your P*P first to obtain a referral. Then, you must choose an ABA provider within the HMO network. If you go outside the network for services, the HMO may not cover the costs, leaving you to pay out-of-pocket.

HMOs often have lower premiums and out-of-pocket costs, but they come with more restrictions on which providers you can see.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “utilization review” applied to ABA:Utilization review is the process by which an insurance com...
14/09/2024

Here’s an explanation of “utilization review” applied to ABA:

Utilization review is the process by which an insurance company evaluates the necessity, appropriateness, and efficiency of the ABA therapy services being provided. This review ensures that the care being given meets the standards for medical necessity and that it aligns with the patient’s treatment plan.

For example, if your child is receiving ABA therapy, the insurance company may conduct a utilization review to determine whether the number of therapy hours being provided is justified based on the child’s progress and clinical needs. The review could involve assessing clinical records, treatment plans, and outcomes to decide if continued services are warranted.

A utilization review can affect whether ongoing ABA therapy will be covered by your insurance, so it’s essential to ensure that documentation and treatment plans are thorough and up to date.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “balance billing” applied to ABA:Balance billing occurs when an ABA provider bills you for the ...
13/09/2024

Here’s an explanation of “balance billing” applied to ABA:

Balance billing occurs when an ABA provider bills you for the difference between the provider’s charge and the amount your insurance has agreed to pay. This often happens when you receive services from an out-of-network provider.

For example, if an ABA session costs $200 and your insurance company only covers $150, the provider may bill you for the remaining $50. This $50 is the “balance” that you are responsible for paying, in addition to any co-pays or co-insurance required by your plan.

Balance billing can result in unexpected costs, so it’s important to verify whether your ABA provider is in-network and what your insurance will cover before receiving services.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

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12/09/2024

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Here’s an explanation of “medically necessary” applied to ABA:Medically necessary refers to services or treatments that ...
12/09/2024

Here’s an explanation of “medically necessary” applied to ABA:

Medically necessary refers to services or treatments that are considered essential for the diagnosis, treatment, or prevention of a medical condition and that meet accepted standards of medical practice. In the context of ABA therapy, a service is deemed medically necessary if it is required to treat a condition like autism spectrum disorder (ASD) and is expected to improve or maintain the patient’s health.

For example, if a child has been diagnosed with ASD, an insurance company may require documentation from a physician or psychologist indicating that ABA therapy is medically necessary for the child’s development. Without this determination, the insurance company might deny coverage for ABA services.

Determining that ABA therapy is medically necessary is critical to ensure that the services are covered by insurance and that the child receives the appropriate care.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “exclusion” applied to ABA:An exclusion in an insurance policy refers to specific services or t...
11/09/2024

Here’s an explanation of “exclusion” applied to ABA:

An exclusion in an insurance policy refers to specific services or treatments that are not covered by your insurance plan. In the context of ABA therapy, an exclusion might mean that certain types of therapy, conditions, or even specific ABA providers are not covered under your plan.

For example, if your insurance plan has an exclusion for in-home ABA therapy, this means that even though your child may benefit from receiving therapy at home, your insurance will not pay for these services. As a result, you would be responsible for covering the full cost out of pocket if you choose to pursue this type of treatment.

Understanding exclusions in your insurance policy is crucial for planning your child’s ABA therapy and avoiding unexpected expenses.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

Here’s an explanation of “claim” applied to ABA:A claim is a formal request submitted by an ABA provider to your insuran...
10/09/2024

Here’s an explanation of “claim” applied to ABA:

A claim is a formal request submitted by an ABA provider to your insurance company asking for payment for services provided to your child. After your child attends an ABA therapy session, the provider will send a claim to your insurance company detailing the services rendered, including the type of therapy, duration, and cost.

For example, after an ABA therapy session, the provider submits a claim for $200 to your insurance company. The insurance company then reviews the claim to determine how much of the $200 they will cover based on your insurance plan, such as applying any deductibles, co-pays, or co-insurance. Once processed, the insurance company will pay the provider their portion, and you will be responsible for any remaining balance.

Submitting accurate and timely claims is crucial for ensuring that ABA providers are compensated and that you, as a client, are aware of your financial responsibilities.

If you have questions, please give us a call at 800-881-8980 or schedule a consult at abaexperience.com.

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