What determines the amount I will have to pay out of pocket?
Your specific insurance plan will determine the amount of costs that you can anticipate paying, whether it goes toward your deductible, copay, or coinsurance. Prior to touring our center, our Billing Team will verify your ABA specific benefits.
What is a deductible?
A deductible is the amount you must pay before your insurance starts paying towards the covered service(s). This amount resets at the beginning of a new benefit period, typically on the 1st of every year. Other services you and/or your child receive outside of Mindcolor will also count toward your deductible.
What is a copay?
A copay is a fixed amount specified by your insurance plan that can accrue per day or per visit; please refer to the benefits email for your specific frequency. The amount of hours per day will not play a part in determining the estimated copay cost.
What is coinsurance?
Coinsurance is the percentage of covered health costs you’re responsible for paying after you’ve met your deductible while your insurance picks up the rest. This is called a shared cost. For example, if you are subject to 20% coinsurance, then your insurance will pay for the remaining 80% of the costs.
What is an out-of-pocket maximum?
An out-of-pocket maximum (OOPM) is the maximum amount of money you are subject to pay to all providers for all services within your plan year. Once you meet your OOPM, your insurance covers services at 100% until your plan resets at the beginning of your benefit period.
What if my benefits are out-of-network (OON)?
While we do participate with many insurance companies, there are times we are not directly contracted with a particular plan. However, your plan may still have out of network benefits to cover services. If so, we will relay them to you to determine if it would be a fit.
Why does insurance require prior authorization?
Insurance requires prior authorization for certain services such as ABA therapy to determine whether services are medically necessary before they are performed. Typically, insurance will review the diagnostic evaluation to confirm a diagnosis of autism.
Who handles prior authorization for my child and what is the typical turnaround time for determination?
Mindcolor submits and manages prior authorizations on behalf of the member. On average, the turnaround time from submission to determination is 15 days.
What happens if my insurance does not fully approve authorization for services? In general, there will be 2 options to appeal by either a member or provider with steps that will be outlined in the denial letter that is sent to the family and provider.
■ Member appeal: Option for the member to appeal the adverse decision.
■ Provider appeal: Option for the member to elect a representative (provider) to appeal on their behalf.
What if ABA is a noncovered service on my policy?
Generally, when ABA is not covered, it is due to an employer electing to not follow the autism mandate requiring insurance coverage of ABA services. As a provider, unfortunately, we have limited recourse to overturn this. In this situation, we suggest the subscriber reach out to Human Resources on how to add specific coverage of ABA therapy to the policy. Once ABA coverage can be confirmed, the intake process can resume.
Can I choose who I want to bill if I have more than one insurance?
In short, no. When a child is covered by both parent’s benefits, coordination of benefit (COB) rules will apply in determining in what order claims need to be submitted.
What is coordination of benefits (COB) and how is it determined?
When you verify your COB, this tells insurance companies how they will split the costs of your services across multiple insurance policies. It is critical that there is an up-to-date COB on file with all active insurance policies. If COB is neglected, higher than usual patient costs may incur due to no coverage until updated.
Typically, it is determined using a method called the ‘birthday rule’ in which the parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent.
How can I get a copy of my bill?
Please reach out to our billing department at billing@mindcolorautism.com to obtain a copy of your most recent statement.
Do I need to pay for services up front or at the time of service?
No, while ABA therapy is typically fully covered by insurance, we understand the potential costs from patient responsibility (deductible, copay, coinsurance) and how it may impact our families financially. We provide customizable options to create a personalized payment plan over the course of services throughout the year to meet your financial needs. As part of our financial agreement, we require all of our families to create a payment plan by placing a card on file at the onset of services.
Why am I still making payments if I met my OOPM months ago?
Most patients will meet their OOPM rather quickly but with our payment plan, your overall balance is spread over several months, which alleviates the upfront financial burden, resulting in potential payments after it has been met. Once your balance has been satisfied, we will cancel your payment plan until the following benefit year when benefits reset.
Will I get billed for days that my child does not attend direct therapy?
No, you will never get billed for any unattended days of direct therapy when your child is not directly seen by Mindcolor. This includes sick days and holidays, etc.
Why did I get billed for multiple days of an assessment when my child was only there for one day?
Insurance covers the portion of the assessment process where Mindcolor is analyzing data, scoring/interpreting the assessment, and writing/preparing the treatment plan report. These events may happen on other days when the child is not there and typically spans multiple days.
What is supervision billing?
Supervision billing refers to "BCBA Supervision" which is a requirement for ABA therapy. This service allows for your child's BCBA to supervise the tending RBTs on the case to ensure they are following all goals and programming; along with providing additional support during direct therapy sessions.
What happens if I change insurance?
Please let the Billing Team know as soon as possible if you are aware that your insurance is changing, or if you are looking to change, to avoid a potential impact on services. While we do participate with most large insurance plans, we always recommend double checking that the new plan will cover ABA therapy and that they are in network with Mindcolor. If you need assistance verifying these details please contact the Billing Team.
Does Mindcolor take Medicaid?
Mindcolor accepts Medicaid in certain states and centers.
If we do accept Medicaid in your center, we will bill all active policies. Please note that you will still receive explanation of benefits from your primary insurer outlining our patient costs. This does not indicate that your Medicaid policy was not billed.
What happens if my child is approved for Medicaid during treatment?
We kindly ask that you notify the Billing Team in a timely manner. While eligibility most likely will be backdated, authorization for ABA therapy will be required with the new Medicaid policy. After we submit for prior authorization once we receive notification of the active policy, we may not be able to backdate the authorization start date for services to be covered by Medicaid. This may result in continued patient costs that will still be collected by Mindcolor until the approved authorization is active.
Do you accept private pay for ABA services?
No, we do not offer ABA therapy without insurance coverage.
What should I do if my insurance sends claim payments directly to me?
Any insurance payment for services rendered by Mindcolor, whether from primary or secondary, should be paid to Mindcolor in a timely manner. Mindcolor is notified when payments are made to the family and will also reach out inquiring about payment. Clients are fully responsible for the outstanding charges. Insurance checks can be signed over to Mindcolor including the explanation of payment. Or, the client can deposit a check into a personal account and remit payment to Mindcolor for the outstanding balance(s).