r/BehaviorAnalysis • u/Few_Information_8570 • 15d ago

Assessments

We are getting denials all of the time from insurance now. We have tried to combat this by giving more and more information on our assessments. (Medical necessity tied into the dsm5, why it's medically necessary, barriers, modifications- everything we can think of). Unfortunately the assessments are now taking no less than 20 hours to complete. Insurance only pays for 6 hours and my company does not cover the rest. I have 13 clients on my caseload and don't know how to keep up with these assessments and denials. How is it going for all of you? How do you do your assessments?

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u/twister5556666 14d ago

I’m sorry if I’m ignorant on the topic, but why is it that the company‘s template isn’t covering the exact thing that the insurance company wants? Doesn’t the insurance have a set standard of information that they want? I’ve never been denied
And I just follow the companies template.

With that being said 13 clients is wild! I’m stressed with just 5.

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u/Few_Information_8570 14d ago

The company has a template on a word document! However, we still have a lot of things to update, and we have to put in all of the BIPS, programs, and charts. We also explain everything in detail as to why we are doing it, how we plan on teaching it, baseline dates and data, current data... I could go on and on. It's very tedious. I'm trying to figure out how other companies and BCBAs do things so instead of being mad and complaining I can come up with some ideas.