Are you a parent seeking an autism evaluation for your child? Or maybe you tried to enter into ABA therapy but ran into insurance issues. Whatever your situation, starting the journey to support your child’s development can be stressful, overwhelming, and confusing. But you are taking the right steps in seeking help. That is why we want to provide you with information on our autism evaluation process. Here is a detailed breakdown of how it works.
Where to Start
Maybe you are concerned about your child’s development, or your pediatrician is recommending an autism evaluation. Whatever the reason, it can be confusing to know where to start. In order to access autism therapies if they are on your insurance plan (such as ABA, speech therapy or occupational therapy), most insurance companies need an autism evaluation. Most insurance companies require an evaluation that includes a series of standardized assessments. Additionally, they need a report with the data of those assessments to support a concluding diagnosis of Autism Spectrum Disorder. These evaluations are typically performed by a qualified psychologist or neuropsychologist. It’s important to note that most insurance plans require something more than a simple neurologist diagnosis; neurologists do not use the standardized assessments insurance looks for.
What to Expect
The overall evaluation process at Healing Haven is not very long. It consists of three appointments which total roughly six hours altogether (depending on the child’s age and level of skill.) The turnaround time from the first appointment to receiving the final report averages about one to two months. However, that time depends on the facility performing the testing.
However, the wait to receive the assessment is generally the biggest issue. Most facilities that offer quality evaluations have waitlists of several months or more. But time is precious when it comes to a child’s development. Those several months can make a huge difference when it comes to receiving services.
One of the most impactful things you can do as a parent is obtain a clearer understanding of your child’s difficulties. At Healing Haven, we try to keep all evaluations–from the time parents contact us to when they receive results–within three months. This way, if intervention is necessary, it can be accessed as soon as possible.
The Autism Evaluation Process
Our autism evaluation process is typically divided into three appointments.
During the first appointment, a parent or guardian meets with the clinician. They will discuss background information, family history, and any concerns regarding their child’s development.
The second appointment involves the direct assessment of the child. The clinician utilizes several standardized assessment tools to gather objective data on the child’s skills and their behaviors. The clinician will use this data to reflect the child’s developmental progression in comparison to other children of the same age.
After these two first meetings, the clinician compiles all the information gathered into a report. In the third and final meeting, the clinician goes over the report with the parent(s)/guardian(s). Based on data and historical information, this meeting will specify whether a child may fall within the criteria of Autism Spectrum Disorder. If the child does not meet the criteria, parents and guardians may learn if something else is going on that better addresses their concerns (e.g. speech delay, learning impairment, anxiety, etc.)
Whether your child is on the spectrum or not, a developmental assessment provides a detailed evaluation of your child’s current level of skill and developmental status. A developmental assessment identifies factors contributing to your child’s difficulties, rules out diagnoses that may mislead treatment, and provides you with direction to address your child’s specific needs.
What to Look for in an Autism Evaluation Provider
The most important question to ask a facility offering evaluations is, “If my child is diagnosed, will this report unlock insurance covered ABA services?” You’re investing in a lengthy process. So you’re entitled to all the necessary information to access insurance covered services (if needed). Make sure you know which questions to ask to understand exactly what insurance requires for ABA services.
However, many facilities that offer autism evaluations are unaware of the specific insurance requirements for ABA services. So, many testing facilities may be honest saying that they can provide an autism evaluation but are unsure if insurance to cover ABA services will accept the type of evaluation provided.
At Healing Haven, we’ve had countless families who had their child previously evaluated. But they found their diagnostic report was missing components insurance requires in order to accept the diagnosis and access services. Thankfully, some insurance companies are lenient and allow us to fill in the missing components. Other times, too many components were missing, requiring an evaluation re-do. Obviously this is time consuming and costly. It is also a significant barrier to receiving services. So again, do your best to make sure that what the testing facility offers will be sufficient for your insurance.
An Important Note about BCBS/BCN of Michigan
Many families in our area have insurance through Blue Cross Blue Shield of Michigan or Blue Care Network of Michigan. For BCBS/BCN members it’s important to know that they have a list of centers for which they will accept an autism diagnosis. These specialized locations are called Approved Autism Evaluation Centers (AAEC).These AAECs are spread throughout the state, but unfortunately can have long waitlists – sometimes up to 12 months. As a result of these long waitlists, and because early intervention is so critical, BCBS and BCN will accept an autism evaluation from a qualified psychologist or neuropsychologist if it meets its standards. They call this type of evaluation a “Bridge Authorization”. This authorization serves as a place holder, allowing families to access services while they remain on a waitlist at an AAEC.
We understand how time-consuming and worrisome the autism evaluation process can be as you strive to get support for your child. But we are here for you and you are not alone in this journey. If you have questions or you’re interested in starting an evaluation, please reach out to us.
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