Frequently Asked Questions

Q: What is Autism?

Autism, or autism spectrum disorder (ASD), refers to a condition with a broad range of symptoms characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication.

According to the Centers for Disease Control, autism affects an estimated 1 in 36 children and 1 in 45 adults in the United States today.

Autism is a spectrum disorder. Each individual has different strengths and challenges that may affect how they think, learn, and solve problems. Autism ranges across three levels, from highly skilled to severely challenged, and each person with autism has a distinct set of strengths and challenges. The severity level often identifies how much support the individual will need to complete day-to-day activities.

Q: What insurance plans do you accept?

A: Odyssey Behavioral Health Clinic: ABA Clinic currently accepts the following insurance plans:

Blue Cross Blue Shield
Aetna
Cigna
TRI-CARE - East
United Health Care
Optum
United Behavioral Health Care
United Medical Resources
Magellan

Odyssey Behavioral Health Clinic: Mental Health Clinic currently accepts the following insurance plans:

TRI-CARE - East
Self-Pay

We do not accept Government Health Insurance plans (CHIP, Medicaid or Medicare)

Odyssey Behavioral Health Clinic will check benefits for your insurance carrier and work with your carrier to help your family get the best possible rates.

Q: I would like information about accessing my insurance benefits for ABA services. What should I do?

A: First, the Odyssey Behavioral Health Clinic must verify eligibility for ABA benefits from the insurance company. To do so, please contact us, so we can provide you with an insurance intake form to complete and return to us via mail, fax or email to:

Address:

Odyssey BHC

3501 Sheppard Access Rd.

Wichita Falls, TX 76306

Email: OdysseyBHC@OdysseyBHC.org

Phone: 940-386-2100

Fax: 940-386-2101

Q: My child does not have a diagnosis of autism. Will insurance cover ABA services?

A: ABA can be an effective intervention for a wide range of conditions. The benefit of coverage for ABA at this time is limited to conditions related to Autism Spectrum Disorders. However, ABA treatment for other diagnostic conditions may be appropriate, and coverage may be available through limited standard behavioral health benefits or scholarship opportunities for some services that may be available.

Q: What if my child does not have insurance?

A: During intake, our team will help your family identify the likely funding sources and the available services for your specific situation.

Q: Why would my child get denied ABA services from insurance if the mandate requires insurance funding?

A: Possible reasons you might receive a denial are listed below:

1. ABA services are not a covered benefit.
2. Clinical issues related to the medical necessity requirements not being met or the provider not meeting requirements.

Most states and health plans have an appeal process, and the intake specialist will help you begin the appeal process where appropriate.

Q: How long does it take for the insurance company to authorize ABA services?

A: It isn't easy to give an accurate timeline. Some insurance companies have provided authorizations for an assessment within a week of inquiry, while others take longer. We are here to support the authorization process and keep it timely and efficient.

Q: What is the process to getting an authorization after the assessment?

A: Insurance companies have been authorizing approximately 6 to 8-hour assessments (every insurance company is different). Once the assessment is submitted, the insurance clinical team reviews the goals, treatment plan, and recommendation for service before authorizing ABA services, which could possibly take up to 21-days to get feedback or approval.

Q: I am concerned about paying the co-pay for each session.

A: Some families and individuals may qualify for co-pay and deductible assistance. Please contact our staff so we can connect you with scholarship programs.