What to Expect

We understand that there are many questions, thoughts, and concerns when searching for ABA services for the first time or when looking for a new provider. We are here to help you the best we can through every step of the way. The following steps will give you some insight on the process and guide you on how to get started with us.

 

1. Contact Us

To request services, complete our online intake form or call us.  An initial pre-intake phone conversation and a review of your submitted intake form will allow us to better understand your child's needs, if they are within our scope of practice and if our service delivery model is the best fit. This conversation will also give you a chance to learn more about our ABA services and ask questions. The goal of this conversation is to determine if we are a good fit for each other.

2. Verify Eligibility and Health Insurance ABA Benefits

Once we have determined if your child's needs are within our scope of practice and they are a fit for our service delivery model, if you are using insurance as a funding source, we will verify eligibility and health insurance ABA benefits. *Eligibility verification does not apply to private pay clients. 

3. Request Pre-Authorization for Assessment

Once we have verified eligibility and ABA insurance benefits, we will discuss your health insurance benefits and ABA coverage with you and any out of pocket expenses (deductibles, co-insurance, co=pays, etc.) If you agree to move forward, we will request that you send us important documents needed to request authorization for an initial assessment such as your child's comprehensive diagnostic report, the prescription/referrals/doctors order for ABA services, and others depending on your individual health plan. If you do not agree to move forward, we can discuss other options such as referral to another service provider. If approved for the initial assessment, we will then reach out to schedule an intake appointment with you and your child. While we wait for the initial assessment, approval, we will send you intake documents to review, sign, and complete. *Document requirements for pre-authorization for assessment varies by insurance provider and do not apply to private pay clients* *Initial assessment authorization approval can take up to 3 weeks and depends on your insurance carrier. In order to ensure timely approval of assessment, we ask that you submit all relevant documentation within 24-48 hours of our request. We will not move forward with requesting an initial assessment until all documents have been received *

4. Intake: Conduct Initial Assessment and Client Services Agreement

During the intake appointment, a BCBA will meet with you and your child and gather information about your child's medical history, treatment history, strengths, deficits, behavioral concerns and more. We will also gather information about your needs as a parent and how we can help you. The BCBA will also conduct an initial assessment which includes interviews, several observations of your child (may include various settings if needed), administration of direct assessment tools (involves directly working with your child), and data collection. During the intake appointment, we will also provide you with our Client Services Agreement that outlines our policies and procedures for services and discuss availability/ scheduling.  The intake appointment is conducted in person and can last anywhere from 1.5-3 hours.  *Depending on your child's individual needs, the initial assessment process can take anywhere from 1-3 weeks. *

5. Develop Treatment Plan & Request Service Hours

After the BCBA has completed the assessment, they will then work on developing a treatment plan based on the assessment results and information they have obtained from you. The treatment plan will include information we gather from the intake appointment, results from the initial assessments, along with behavior reduction goals, skill acquisition goals, parent training goals and the recommended number of treatment hours we determine is medically necessary to provide treatment & meet these goals. The treatment plan will be reviewed, approved, and signed by you prior to submission to the insurance provider. Once the treatment plan has been approved by you, we will submit a final copy to your insurance provider to get authorized for ABA services.  *Depending on the child's individual needs, the treatment development process can take anywhere from 1-3 weeks; authorization for service hours varies by insurance and can take up to 3 weeks. does not apply to private pay clients*

7. Start services!  :)

Once we have received approval and an official authorization letter from your insurance provider, we can begin services at the times and days agreed upon during the intake appointment. The length of time authorized for ABA treatment as well as the number of service hours approved will vary depending on your insurance provider. If at the end of the authorization period we find it medically necessary to continue services, we will request for reassessment and an authorization to continue treatment. If for any reason your child is denied services, we will follow up with your insurance provider and try our best to determine the reason for denial and find a resolution.

***Please be advised that the length of time between our first initial contact and the actual start of services can be anywhere from 1- 2 months and is dependent on several factors like timely provision of all required documentation, your insurance providers processes and your child's individual needs.***

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©2020 by Pivotal Achievements, LLC.

7451 Wiles Rd #107 Coral Springs, FL 33067

 info@pivotal-achievements.com

P: 954-893-2442

F: 954-516-7631