Frequently asked questions about ABA treatment and home-based therapy

Whether you’re interested in learning more about Novel Responses’ approach to home-based therapy and ABA treatment, or you’d like to know what options are available for addressing your child’s problem behavior, we’re confident that we can help. Below, you will find a number of frequently asked questions. If you can’t find the answer that you are looking for, we encourage you to reach out to us via our contact page.

Applied behavior analysis (ABA) is defined as the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior.

In intensive 1:1 settings and in the natural environment, behavioral procedures such as reinforcement, extinction, shaping, chaining, prompting, and fading are used to change the behaviors and to teach critical language and learning skills to children with autism.  Emphasis is placed on analyzing why certain behaviors are occurring and how caregivers may be able to change their own behavior to bring about positive changes in the behavior of the child.  Behavioral strategies are developed to meet the specific needs of the child.

Novel Responses, Inc. provides therapy in the client’s home.  Therapy can also take place in the community depending on the needs of the client.

Our BCBA (Board Certified Behavior Analyst) Clinical Supervisors, with extensive experience in behavioral programming for children with autism and other developmental disabilities, create treatment plans based on the unique needs of the client. The BCBA Clinical Supervisors oversee the behavior technicians who carry out the therapy, typically 10-25 hours per week.

Virtually, any skill can be taught using the principles and methods of ABA therapy. Skills are broken down into small steps and taught in a logical sequence one step at a time. In addition, behaviors that need to be reduced or eliminated can also be targeted.  Objectives in the following skill areas can be developed and taught to meet the individual needs of the client: critical language and learning skills, social skills, play skills, activities of daily living, executive functioning skills, and the reduction of problem behaviors and acquisition of replacement behaviors.

Our Clinical Training Department focuses on the support of our client programs and our staff in
the field. The Clinical Training Department is responsible for training systems, including initial and ongoing behavior technician training. The Clinical Training Manager plans Professional Development Days, focused training events, and other training activities to increase the skill level of our Behavior Technicians.

The Clinical Training Department also houses our Case Support Department. Behavior Technicians who have advanced to the Case Support Behavior Technician role provide support and additional training to the direct behavior technicians on the client cases.  Often, these Case Support Behavior Technicians are pursuing their certifications as Board Certified Behavior Analysts (BCBA) or BCaBA (Board Certified Assistant Behavior Analysts) and have acquired higher-level technician skills at Novel Responses while completing the requirements for board certification.

Novel Responses, Inc. provides behavioral services in the following cities and surrounding communities in Michigan: Ann Arbor, metro Detroit, Lansing, Kalamazoo, Grand Rapids, and Petoskey.

Michigan’s Autism Insurance Reform legislation (PA 99 and PA 100 of 2012) went into effect on October 15, 2012. For-profit, commercial, HMO, and non-profit health insurance companies regulated by the state of Michigan are mandated to provide an autism benefit to its insured members covering services related to the diagnosis and treatment of autism spectrum disorders (ASD) through 18 years of age.

Self-funded insurance plans are regulated by Employee Retirement Income Security Act commonly referred to as ERISA through federal law. Self-funded insurance plans are not mandated to provide autism coverage.  However, if a self-insured company self-adopts an autism benefit whereby employees are offered autism coverage by the self-insured plan, then the self-insured company either directly or through its third party administrator (TPA) may submit reimbursement request(s) to cover the cost of the paid claims to the Autism Coverage Fund.

If your health insurance coverage is provided by an out-of-state employer/insurance carrier, then they are governed by the laws of the state in which the plan is based.

So although many more insurance carriers provide this benefit today, it is still necessary to confirm the benefit availability for your specific plan with your insurance carrier.  We are able to provide you with the procedural codes and diagnostic codes associated with treatment to insure the most accurate information.

Blue Cross Blue Shield of Michigan, Blue Care Network, Health Alliance Plan, Optum, United Health Care, Golden Rule, & Beacon Health Options.  We are sometimes able to do a single case agreement with other insurance companies if they don’t have many participating providers in the market area.

Out-of-pocket costs are determined by your individual insurance plan, so it is very important to know the details of your coverage.  Some plans require a client co-payment per date of service for therapy.  However, other plans require that your deductible be met before you begin cost-sharing a percentage of co-insurance for all services provided until an out-of-pocket maximum is met for the benefit year.  Please review your Summary of Benefits that you would have received at enrollment time or may also be found online at the insurance company’s website.  You can also contact the customer service number found on the back of your insurance card to find out more about your plan.

Most insurance companies do require pre-authorizations for ABA services to be provided.  Depending on your insurance company we will work with their Behavioral Management Department to submit the request for authorization of services.  Each insurance company has different documentation requirements, but most do require a diagnosis from a specified center or a primary care physician.

Novel Responses submits insurance claims on a biweekly basis to the insurance companies with whom we participate.  Those insurance carriers typically respond with payment or cost-sharing allocation information within 30-45 days.  Upon receipt of that information, the patient cost-sharing amounts are allocated to your account and an invoice will be sent by email on a monthly basis around the middle of each month.  A summary billing statement is also emailed out shortly after the start of each month.

You have the option to purchase a plan on the Marketplace (typically you would look at a child only plan). We can also provide you with direct billing programs and rates appropriate for your child’s needs.

Coverage for ABA through the Health Insurance Marketplace – Autism Speaks

https://www.autismspeaks.org/node/300226

BCBSM/BCN Approved Autism Evaluation Centers List

http://www.bcbsm.com/content/dam/public/Common/Documents/approved-autism-evaluation-centers.pdf

About Behavior Analysis – Behavior Analysts Certification Board

https://bacb.com/about-behavior-analysis/

8 Step Guide to Insurance Coverage for Autism – Friendship Circle

http://www.friendshipcircle.org/blog/2012/07/16/an-8-step-guide-to-insurance-coverage-for-autism/

Some Common Questions About Insurance – Autism Alliance of Michigan

https://autismallianceofmichigan.org/insurance-facts/

Who do I contact for information about applying for services with Novel Responses, Inc.?

Families who are interested in obtaining services or more information about Novel Responses, Inc. can send an email to client.services@novelresponses.com.  Please include your child’s age, your town of residence, and contact information. You can also call Michelle Persails, Director of Service Coordination, at 269-321-9556.

Learn what we can do to assist your child today

Call us at (269) 321-9556