Five Things to Know About Your Insurance Plan Before Your Child Starts ABA

Posted on August 1, 2018 · Posted in Parent Tips

Providers can see hundreds of different insurance policies in a year, all with their own unique requirements and benefits. As a provider, they cannot guarantee insurance coverage. Knowing this, it is extremely important for each family to be familiar with their insurance policy and its benefits. The more informed a family is, the better prepared they are for when insurance mishaps take place to help get them resolved effectively and efficiently.

Below are five key tips to use when contacting your insurance company for information:

  1. When you are needing to find out if a service is a benefit on your policy, check your online insurance account or give the insurance representative a call. There should be a member services phone number on the back of your insurance card.
    1. If it is not a routine type of service, give the rep the procedure code your provider will be billing. They will be able to look it up and see if it is a covered benefit. (Your provider should be able to give you the procedure code(s) if you ask.)
  2. Make sure to check what the stipulations of the coverage are, such as:
    1. What diagnoses are/are not covered under the benefit
    2. Number of sessions/visits permitted
      1. Soft limit (can request more based on medical necessity)
      2. Hard limit (once visits are used, no more visits can be billed to insurance until policy renews)
    3. Is a referral from a Primary Care Physician (PCP) needed for the service?
    4. What is the patient’s payment responsibility for the service?
    5. Does a copay or deductible and coinsurance apply to the service?
  3. Insurance reps will generally only give answers to specific questions asked. If there is something you are curious or unsure about they did not mention, make sure to ask.
  4. Always get a reference memo to a call you make to an insurance rep, as you may need to use it in the future. References are often:
    1. The name of the person you spoke with and a number
    2. The name of the person you spoke with, the date, and time of the call
  5. It is extremely important to be polite and direct when contacting insurance, as often insurance reps will only know information pertaining to their specific department. Keep contacting until you get to a rep (or multiple reps) who can help answer all your questions.

At Metro West Learning Center, LLC, our business office goes above and beyond when helping families with their insurance questions and coverage. Please contact Megan Brunk at 515-987-8835 with any related questions.