These dates tell you the period of time that services were approved. If services are being provided outside of these dates, they may not be covered. As the end of your authorization comes up (e.g. a month before the end date), check in with your provider to ensure that the new authorization request has been initiated as insurance review timelines can be lengthy.

What Services Were Approved?

Each code represents a different type of ABA Service (e.g. assessment, treatment, parent training, etc.). The codes help you understand what kinds of services were approved.

Insurance companies often use “units” to describe what was approved. Here is a quick way to understand what a “unit” is!

The Approved Units in your letter tells you how many units/hours are approved per week, per month, or per authorization period.

If you utilize more services than what was approved, insurance will not cover anything above what was approved.

On the other hand, if you use too few units/hours during an authorization period, insurance doesn’t like that either. If you consistently under-utilize your hours, there is a good chance your insurance will not authorize similar numbers of hours in the future, regardless of need (e.g. if your BCBA asks for 20hrs of therapy per week, insurance may only approve 10hrs per week).

Ensuring you are utilizing 80% to 100% of your approved units/hours is essential to ensuring therapy effectiveness and insurance compliance with utilization.

If you receive an ABA Denial instead of an approval, don’t panic — we have a guide for that, too. 💛

Check out our step-by-step guide below:

We are here to make complicated services a little easier to navigate. Send us the questions you're running into—from ABA authorizations and insurance to Medicaid, IEPs, and planning for adulthood—and we'll continue breaking down the information you need. Send us an email at: [email protected]