Diagnostic Report for Insurance Carriers

Insurance companies now routinely require that we provide a current (within the last 3 years) diagnostic report in order for them to approve our request for authorization for ABA services. We have additional guidance that you can share with your provider when scheduling a diagnostic evaluation or assessment to make sure they are scheduling the right type of appointment, using appropriate diagnostic instruments, and providing the necessary information in a report.

WHO CAN PROVIDE MY CHILD WITH A VALID DIAGNOSTIC REPORT?

The type of provider to schedule an appointment with is either a doctor (MD, DO) or a Licensed Clinical Psychologist (PhD, PsyD) who performs diagnostic evaluations for children/adolescents with Autism Spectrum Disorder. The Developmental Behavioral Pediatricians in the area often have long waiting lists, so if you have a developmental pediatrician who you already see for this type of appointment please contact them months in advance. Licensed Clinical Psychologists usually have appointments available sooner, but not all Licensed Clinical Psychologists provide diagnostic evaluations/assessments for children/adolescents so it’s important to discuss the type of appointment that you need.

HOW OFTEN DO I HAVE TO GET A REPORT?

IF your child has a prior diagnostic report but the report is more than 3 years old, when you call to schedule a new evaluation you can let the provider know about the previous evaluation and report, so they can determine if all that is needed is a “reevaluation” or “re-assessment.” This will take less time and can probably be scheduled sooner.

IF your child has not previously had a formal diagnostic evaluation they will need a “full evaluation” or “full assessment” provided by a qualified diagnostician for Autism Spectrum Disorder.

What are the requirements for a DIAGNOSTIC report?

The following is what is required in a report. Please share this with your provider when you are scheduling an appointment so they know what is needed:

* The diagnostic report must be completed by a doctor or Licensed Clinical Psychologist

* Include at least one diagnostic instrument they ran (ex: ADOS, CARS, GARS, ASRS, ABAS)

* Provide all of the doctor’s detailed observations

* Note all current diagnoses

* Include the doctor’s current recommendations.

Accepted Insurance Providers

*We are able to join HMO networks at the discretion of the network. Current BCBS IL HMO networks: Unified Physicians

We also provide services for Self-Pay Patients

Please contact us for details or questions about billing and Insurance.