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State regulated, fully funded health plans vs self-insured ERISA plans

Do you have a state regulated “fully funded” health plan or a self-insured “ERISA” plan? This is an important distinction because the state mandated insurance for Florida and many other states do not cover self-insured ERISA plans. Typically companies that are very large have self-insured plans that they allow the health companies to manage. It is still possible for your self-insured plan to cover ABA for autism. It is all in the fine print of your “Evidence of Coverage or “Plan Description” manuals.

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In Network vs Out of Network

This may be an important distinction for you as your out-of-pocket costs can be, but is not always, affected by this distinction. Since there are not many innetwork providers of ABA services, insurance companies have to write single case agreements and as a result, the care is considered to be in-network in most cases.

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  1. Completed Intake Form
  2. Front and Back copy of your Insurance Card
  3. Upon completion of your insurance assessment BMC will confirm receipt of the form and insurance card with you and will request initial hours for assessment from your insurance company. Once the assessment services have been approved, send us the following:
    1. A copy of a report indicating a Diagnosis of Autism (Diagnostic codes: 299.0; 299.8) by a licensed practitioner (not a school report).
    2. A prescription for ABA services by a physician.