The 4 Primary Sources of Funding
There are 4 primary sources of funding for services available to individuals with Autism Spectrum Disorders (ASD). Families may choose to pay privately for therapies; the school may provide additional supports and educational services through an Individualized Education Program (IEP); the Regional Center may cover a diverse range of services; and insurance companies may cover behavioral treatment for children with an ASD diagnosis. The steps to securing services via any of these funding sources can be challenging to navigate. At Working With Autism, it is our goal is to provide you with a broad overview of this process, your choices, and assist you with any questions pertaining to accessing services.
1. Private Therapy
Parents may choose to pay for private therapies that are not covered by insurance or offered by their Regional Center or school system.
2. Regional Center Services
Infants or toddlers may be eligible for services through the Regional Center if they have one or more of the following:
- An established risk condition (a diagnosed medical condition that has a high probability of resulting in a developmental delay or disability).
- A one-third delay in one or more areas of development before 24 months, or after 24 months, a fifty percent delay in one area or a one-third delay in two or more developmental areas.
Children ages 3 and older may be eligible for Regional Center services if they have a Developmental Disability. More specifically, mental retardation, epilepsy, cerebral palsy, or autism, are all conditions that qualify a child to receive services through the Regional Center.
You must apply for your child to become a consumer of the Regional Center (RC), and the RC will complete an evaluation to assess your child’s development. Upon completion of the evaluation, a determination of eligibility will be made. The RC can provide an array of services, ranging from respite to parent support groups, social skills groups, behavior intervention, and numerous others. RC services can be secured for your child through their development into adulthood.
3. School Based Services
A child who has difficulty learning and functioning in the school setting is also eligible for support services. The presence of a disability doesn’t automatically guarantee services. The disability must have a negative impact on the child’s functioning at school. Eligibility is determined by having a multidisciplinary team of professionals evaluate a child using standardized tests, observations, and evaluations of work samples. Parents and educators subsequently come together to review the evaluation findings and develop the IEP as means of promoting a child’s success in the school environment. The IEP describes the goals that are most appropriate for a child during the course of a school year and identifies the supports necessary for the child to achieve those goals. Supports can range from academic modification and extended time on activities, to having speech therapy services or a one to one behavioral aide. The IEP should be reviewed annually to update goals and ensure that the appropriate levels of support and services are in place. As a parent, you can request an IEP at any time to discuss your concerns and request more, fewer, or different services.
4. Services Covered by Health Insurance
Effective July 1, 2012, a law has taken effect, which mandates insurance companies to cover behavioral health treatment for autism or pervasive developmental disorder. “Behavioral health treatment” includes Applied Behavior Analysis (ABA) and other evidence-based therapies. Speech and occupational therapy services are also covered by this law. Health insurers may require prior authorization, copayments, and/or other cost-sharing. WWA has been diligent in establishing contracts with the major insurance carriers in order to allow families this additional option as a means of securing our services.
The process of accessing services through Insurance can be a daunting undertaking. A WWA Insurance expert can provide families with necessary support and guidance to make this process easier. We have staff dedicated to performing managed care contracting, coding, and authorizations. In addition, our staff has contacts with Insurance companies and knows the right questions to ask to obtain accurate information. If you would like our assistance in obtaining an Insurance authorization for your child to receive behavioral services, please download our eligibility form or click here to apply online. Our Insurance and Billing Specialist will use the information provided to find out what services your child is eligible to receive, including the amount of your copay/coinsurance and deductibles. We can also determine if pre-certification is required to begin the assessment process or if you can access services with WWA immediately.
Click here to download the WWA Eligibility Verification Request form.
Please print and complete the form, and then scan and email or fax it to us
WWA is contracted with the following health insurance companies to provide intensive ABA treatment services:
- Anthem Blue Cross
- Blue Shield of California
- Magellan Health Services
- United Behavioral Health
- LifeSynch a Humana Company
Working with the insurance companies to access behavioral services is a new and rapidly changing process. In striving to remain up to date with the various insurance requirements and specifications, our staff attend online workshops and are in daily contact with the insurance companies to gather pertinent information. We strive to deliver our knowledge and assistance to any family interested in learning about this process. We recommend that you check back frequently as our website and Facebook pages will continue to have updates on the processes involved in accessing therapy through insurance, as well as answers to many frequently asked questions pertaining accessing your funding services.
After APPLYING for services, the next step in LEAP would be to…
PREPARE for your child’s therapy »