Autism Parent Resource Center
The following resources have been developed to help parents of children with autism spectrum disorders navigate the health insurance industry and find treatment for their child.
Autism FAQ - answers to questions about the new law.
Glossary of common insurance terms
Making sure your child’s autism treatment is reimbursed by insurance - a step-by-step guide
Check with your insurance company to confirm that your child’s health care provider is part of the company’s network of providers.
If your child is prescribed applied behavior analysis (“ABA”) therapy, make sure that your ABA therapy service provider is licensed by the state of Mississippi. A list of Mississippi licensed ABA therapy providers is available on the Mississippi Secretary of State’s Office website. If your provider is on this list, you will also need to confirm that they are in-network with your insurance company.
After your child has been diagnosed and your provider discusses what treatment options they recommend, you should call your insurance company. You need to ask if they require prior authorization or pre-certification for that type of treatment. If so, you need to ask the following questions:
What are their procedures are for prior authorization or pre-certification?
What information or documentation they will require to preauthorize or pre-certify the treatment?
Do they need just the treatment plan or any additional information?
Will each type of treatment or therapy need to be individually pre-certified or just the treatment plan?
Verify the insurance company’s address or fax number your provider’s office will need to send this information. You may need to provide this information to your provider’s office staff.
Take notes on your call that include the date and time of your call and the name of the person you spoke with.
If you send any information to the insurance company, make sure that you send it in a way that gives you some proof of delivery – be it a fax delivery confirmation, certified mail or overnight delivery
Keep a copy of any information or documents you send to the insurance company.
Prior to your child’s first treatment appointment, follow up with the provider’s office to make sure that they have provided everything your insurance company requires and that they have received the preauthorization or pre-certification number. If the insurance company required a separate pre-certification for each type of treatment or therapy, make sure that each provider has obtained that pre-certification number. Keep a record of any pre-certification numbers that you or any of your providers obtain.
Ask your insurance company about the difference between in-network and out-of-network coverage. Use a medical provider that is in your health plan’s network usually leads to lower out of pocket costs. Some health plans may not pay for treatment if you do not use a network provider.
If a treatment or claim is denied, be sure to appeal the denial. Mississippi law requires that insurance companies have grievance or appeals processes that you can utilize. You can call the Mississippi Insurance Department’s Autism Hotline for more information on the grievance and appeals process.
If you are still unsuccessful, you can file a complaint with the Mississippi Insurance Department. The Department cannot make medical determinations; however, we have a process called external review that can examine adverse determinations regarding covered services.
Other Resources
The Modified Checklist for Autism in Toddlers (“M-CHAT”) is one way to start the screening process Autism Spectrum Disorder. The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). The M-CHAT-R/F is an autism screening tool designed to identify children 16 to 30 months of age who should receive a more thorough assessment for possible early signs of autism spectrum disorder (ASD) or developmental delay. Just complete the form below and discuss the questions and answers with your child’s pediatrician.
Modified Checklist for Autism in Toddlers Form (PDF)
You can also take the M-CHAT test now with Free Screening and instant scoring.
Questions or concerns regarding your therapist
If you have concerns with the quality of your ABA therapy provider, you may contact the following entities:
The Mississippi Autism Board
http://sos.ms.gov/autismboard/
601-359-6792
Email: info@msautismboard.ms.gov
The Behavior Analyst Certification Board
Email: http://www.bacb.com
1-720-438-4321
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