Health Insurance/Medi-Cal

doctorsCoordination of Care between Primary Care Physicians  and Behavior Health Treatment Clinicians is key to patient’s progress.

For referrals, please call 1-855-227-1414

 


We are accepting families who have private health insurance and Medi-Cal

If you have questions regarding autism coverage through your health plan,
please call 1.855.227.1414 or email us at insurance@act-works.net


Health Plans that Support Autism Coverage:

health_insurance_logos_2015


Senator Steinberg


Autism and Health Insurance FAQ

 

Same Service different funding Source

SB 946 requires most commercial health plans to provide autism coverage. Please contact ACT for any question you may have regarding your Health Plan and ABA services. We will be happy to check eligibility for you!

 

Will my Regional Center stop funding my child’s behavior health treatment if I have private insurance?

Effective July 1, 2012, all individuals who fall under the diagnosis of Autism Spectrum Disorder must first check with their insurance plan about the coverage of ABA services under their plan. If your insurance company denies the coverage then the Regional Center may continue to fund the treatment.

 

Am I responsible for my deductibles and co-payments?

If you earn more than 400% of the federal poverty level, you may not be eligible for regional center funded co-payment unless there has been an extraordinary event, a catastrophic loss or there was a significant unreimbursed medical cost associated with the care of the regional corner consumer.

 

How much time do I have to check for my “ABA coverage under my insurance plan” in order o my services to not be interrupted?

Some Regional Center will cover your ongoing treatment until the current authorization expires. To be on the safe side, check with the Regional Center and your health plan to make sure you have coverage. ACT can help by contacting your health plan.

 

What is required by your agency to obtain benefits reports on my behalf?

We require you to fill out our “Insurance Intake Form.” You may ask your supervisor for this form or you can contact us at 1.855.227.1414 and request to be transferred to our insurance department. You should have your insurance card in your hand while filling out this form. Along with the form we may require your prescription from your Primary Care Physician or a M.D doctor prescribing for ABA services. This prescription will establish medical necessity for ABA services for your child. We will recommend that you provide us the front and back of your insurance card along with the “Insurance Intake Form.”

 

What are the next steps once I give you my insurance information?

Once you provide us with your information we will call your mental health insurance plan and find out the eligibility and benefits for coverage of ABA therapy. Depending upon your health plan and its coverage benefits there is a possibility of four outcomes:

  1. Approval for complete coverage of benefits: If you are approved for ABA therapy under your insurance plan and if we are “In-Network” with your plan then we will obtain the authorization for the treatment. Obtaining authorization may take from 1 day to 15 days.  After successful authorization is obtained we will explain you in detail about your coverage and will schedule you to begin the intake evaluation.
  2. Partial approval of services (Fewer Hours): The approval of ABA services depends upon your plan. If you have received authorization for fewer hours than what you have been receiving through the Regional Center then we may approach your regional center with all the required documents and will request for funding of shortfall hours. You may or may not be approved for the same.
  3. Out of Network: If you are covered for ABA therapy and we are not in-network with your plan then we will try to obtain a single case agreement for your coverage so that you continue to get treated by our qualified and experienced providers. If we are not able to obtain single case agreements then you can call your health plan and find out which providers are in-network with your plan. Our agency is in-network with many insurance providers and is in continuous process to get in-network with many different insurance companies so within months we may become in-network with your plan and then we can start the treatment of your child, if you have not done so already.
  4. Denial of services: If your insurance company denies your benefits for ABA therapy then we will appeal the denial. We will then forward your denial letter along with the proof of appeal to the regional center and will ask them to authorize the ABA services.