Beginning ABA services can involve clinical questions, insurance requirements, records, referrals, and authorization paperwork at the same time. I know that process can feel like another job for a family that is already managing a lot. My goal is to make the next step clear, tell families what information is needed, and be honest about whether Behave Yourself has the availability and resources to meet their needs.
Insurance Accepted
Behave Yourself LLC currently participates with:
- TRICARE East through Humana Military
- Aetna
- UnitedHealthcare/Optum
Participation and coverage can vary among plans and products offered by the same insurance company. A plan’s deductible, copayment, coinsurance, authorization requirements, and in-network benefits must be reviewed for the individual member.
Insurance-funded ABA services generally require:
- A qualifying autism diagnosis
- Active insurance coverage
- Medical-necessity documentation
- An assessment and treatment plan
- Prior authorization from the payer
Some insurance plans may also require a referral, diagnostic evaluation, or additional records before authorizing services.
TRICARE East Through Humana Military
TRICARE provides ABA through the Autism Care Demonstration. Families may need to complete specific diagnostic, referral, EFMP/ECHO, Autism Services Navigator, caregiver-training, outcome-measure, and authorization requirements.
I have created a separate guide explaining the TRICARE process and what families should have ready.
Aetna
Aetna ABA coverage and member responsibility vary by plan. ABA generally requires prior authorization, and families should verify their network, referral, deductible, copayment, coinsurance, and behavioral-health benefit information.
I have created a separate guide explaining what to ask Aetna and what Behave Yourself may need before requesting services.
Start With a Brief Inquiry
Please begin by using the Contact page. The initial message should include only basic information:
- Parent or caregiver name
- Prospective client’s age
- Town or general location
- Insurance company
- General reason for seeking ABA services
- Preferred way to be contacted
- General scheduling needs
Please do not include detailed medical information, diagnostic records, insurance identification numbers, or other private health information in the website contact form. The Client Registration Form should be completed after I direct you to it. This allows us to have a preliminary conversation before you spend time completing detailed paperwork.
Our Initial Conversation
I personally review initial inquiries and communicate with families about prospective services. During the initial conversation, I will ask questions about:
- The prospective client’s current needs
- The types of support the family is seeking
- Location and scheduling needs
- Current services and providers
- Insurance coverage
- Whether there is a current autism diagnosis
- Current provider availability
This conversation helps us determine whether Behave Yourself may be an appropriate fit before beginning the more involved assessment and authorization process. I prefer to tell families early if location, scheduling, insurance, clinical needs, or current capacity are likely to prevent services from moving forward. Families deserve clear information before gathering records and completing paperwork.
Insurance and Benefit Review
If the initial fit appears promising, insurance information will be collected through an appropriate secure method. Coverage review may include:
- Confirming that the policy is active
- Reviewing in-network participation
- Determining whether ABA benefits are available
- Identifying referral or diagnostic requirements
- Reviewing prior-authorization requirements
- Identifying deductible, copayment, or coinsurance information when available
Insurance verification provides important information, but final coverage decisions are made by the payer. Families are also encouraged to contact their insurance company directly to understand their individual benefits and potential financial responsibility.
Records That May Be Needed
Depending on the payer and prospective client, I may request:
- A copy of the insurance card
- A diagnostic evaluation confirming autism
- A referral or order for ABA services
- Relevant medical or developmental records
- Previous ABA assessments or treatment plans
- School evaluations or educational plans when relevant
- Contact information for other involved providers
I will explain which documents are actually needed for the individual case. Families should not send private records through the public website form or ordinary unsecured email. I will provide instructions for secure document sharing.
Assessment and Authorization
If Behave Yourself can move forward with the case, the next step is an individualized assessment. The assessment is used to understand the client’s strengths, needs, skills, behavior, preferences, and family priorities. The findings are used to develop treatment recommendations and an individualized treatment plan. When insurance authorization is required, the treatment plan and supporting records are submitted to the payer. Services cannot begin until required approvals are received. Authorization decisions and processing times are controlled by the payer. I will communicate with the family about the status, requests for additional information, and the next available step.
Scheduling and Availability
Behave Yourself is a small practice, and availability changes as current clients’ schedules and treatment needs change.
Scheduling depends on:
- The prospective client’s clinical needs
- Authorized service recommendations
- Family availability
- RBT and BCBA availability
- Geographic location and travel time
- The settings in which services are needed
Services are primarily provided in homes and community settings in southern Connecticut.
An insurance authorization does not automatically guarantee that every requested time or number of hours can be staffed immediately. I will be direct with families about current capacity, possible start dates, and any scheduling limitations.
Ready to Ask About Services?
The first step is a brief inquiry through the Contact page. Please share basic information about who is seeking services, your general location, insurance company, and how I can reach you. I will respond to discuss whether moving forward may make sense.
Behave Yourself LLC 