Understanding Insurance at SOAR

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Understanding Insurance at SOAR

Insurances Accepted

SOAR accepts all insurance. If you don’t see your insurance listed here, give us a call. If your provider covers ABA, we take it!

Public Insurances (Medicaid)

  • Amerigroup
  • Coordinated Care
  • Community Health Plan of Washington (CHPW)
  • UnitedHealthcare
  • Molina Healthcare
  • ProviderOne (previously Health Plan of Washington/Apple Health)

At this time, we do not accept Medicare patients.

Private Insurances

  • Aetna
  • Anthem Blue Cross Blue Shield
  • Asuris
  • Blue Cross Blue Shield (All plans)
  • Blue Cross of Idaho
  • ChampVA
  • Community Health Network of Washington Evernorth Behavioral Health (previously Cigna)
  • First Choice Health
  • GEHA
  • Healthcare Management Administrators (HMA)
  • Kaiser Permanente
  • Molina Marketplace Plans
  • Premera Blue Cross
  • Regence Blueshield
  • Tricare
  • United HealthCare 
  • Insurance Verification

Following your child’s diagnosis, check with your insurance to verify that they will cover the cost of ABA therapy. Some insurances may require an ASD diagnosis.

Once you receive confirmation that your insurance will cover ABA, you must find an ABA provider. 

Upon selection, the medical team will send a letter to the provider requesting ABA services and attaching the prescription and DSM-5 diagnostic criteria.

If my child’s private insurance does not cover ABA therapy, what should I do? 

If your private insurance does not cover ABA, you can apply for Medicaid under your child’s name. You must verify that your insurance does not cover therapy. Medicaid would be considered secondary insurance and would not cover the cost if private insurance pays for ABA for specific diagnoses.

If my child does not have a qualifying diagnosis, what should I do? 

Suppose your child does not have a diagnosis that qualifies them for ABA under your current insurance. In that case, you may want to reevaluate them for an ASD diagnosis or remove them from your private insurance and apply for Medicaid. Medicaid’s list of approved diagnoses is broader than that of many private insurers. If your child is on Medicaid, but the current plan does not cover ABA, give us a call! We can walk you through the five Medicaid plans available.

Call us at (509) 999-5657 if you have questions about insurance.

State Medicaid

What is Medicaid? Medicaid is a government health insurance program for people with minimal income and resources. Medicaid does not pay you directly but instead sends payments directly to your health care providers. Medicaid can pay for medical services in your own home or if you live in a residential care facility that takes Medicaid residents. Services are available through managed care or coverage without a managed care plan (also called fee-for-service).

Why should I apply for Medicaid? In addition to ABA therapy (which is considered a medical necessity), Medicaid also covers speech and occupational therapy in school and transportation through Special Mobility Services.

To enroll in WA State Medicaid, visit www.washingtonconnection.org/home.

DSM-5 & ICD-10

It is helpful to have a basic understanding of the codes used to reference your child’s disability. The two systems used are DSM-5 Diagnostic Criteria and the ICD-10 coding system. 

DSM-5 is a diagnostic manual developed by the American Psychiatric Association, published in 2013. Its focus is clinical – to list the symptoms which substantiate the presence of a behavioral health condition.

ICD-10 is a disease classification system developed by the World Health Organization to aid policy and funding.

In summary, the DSM-5 gives mental health professionals criteria and definitions to classify diseases through a common language, while ICD-10 assigns a code for reimbursement in claims processing. Your insurance uses ICD-10 coding and may reference the code “F84” when discussing your child’s disorder. 

F01-F99 – Mental, Behavioral and Neurodevelopmental disorders

  • F80-F89 – Pervasive and specific developmental disorders
    • F84 – Pervasive developmental disorders
      • F84.0 – Autistic disorder
      • F84.2 – Rett’s syndrome
      • F84.3 – Other childhood disintegrative disorder
      • F84.5 – Asperger’s syndrome
      • F84.8 – Other pervasive developmental disorders
      • F84.9 – Pervasive developmental disorder, unspecified

 

Click here to download the brochure.

For more blog posts by SOAR Behavior Services, visit soarbehaviorwa.com/family-resources.

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