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Do you ever wonder if your child’s care would be better if your ABA therapist (BSC/BCBA) worked with your child’s other therapists (ex. SLP, OT) at the same time?  I know many of you do!  Having your ABA therapist working with your child's provider team (speech, OT, special instruction etc.) is part of good care coordination and will help your child make the best progress possible. It also keeps everyone on the same page and allows your ABA Team to lead the program. Co-Treatment is considered a “best practice”.

 

So what can you do if you are told "This can't happen” or “We are not allowed to do that”?

 

If you are told that your BSC (Board Certified Behavior Analyst, BCBA) cannot co-treat with say, your speech pathologist, you should be complaining about that.

 

First you should distinguish between your provider agency saying you can't do this and a true insurance denial. If you have a formal denial from your MCO (managed care insurance company) then you can file a grievance by following the instructions on the denial notice.  If it is just your provider agency saying you can't do it, you can call your MCO (the number on your insurance card) and request help filing a complaint against the agency itself.

 

Obtaining a brief doctor's letter explaining why it is medically necessary and best practice to submit to the insurance plan, in the case of a denial, can help.  (Do you need a sample letter to give to your child’s doctor?  That’s easy!  Go to our website, abainpa.com, click on our Resources tab, and under our Document Downloads you will find a sample letter.)

 

But the best approach is a proactive one that addresses this at the ISP meeting and clearly has this written into the plan. If the provider agency "thinks they can't", they should get a formal response from the MCO. If the MCO says "NO" by denying the request, you should also write to This email address is being protected from spambots. You need JavaScript enabled to view it., and copy Rachel Mann, This email address is being protected from spambots. You need JavaScript enabled to view it. so they will take it up with the DHS (Department of Human Services).  This is an issue that we hope to address in the new regulations coming out by the state and hope to streamline this issue for EVERYONE.  

 

We hope this information is helpful to everyone who follows us.  We want the care your child receives to be as good as it can be.  If you aren’t following us, make sure you like and follow us so you don’t miss out on all our news and updates.  

 

 

 

little puzzleTemplate for Providers: Letter of Medical Necessity for Providing ABA w/Another Provider Type

 

From my family to yours, Have a Great Labor Day weekend!

 

Cheryl Tierney, MD

President, ABA in PA INITIATIVE

Section Chief, Developmental Pediatrics, Penn State Children's Hospital