Client Pre-Authorization Denied For Much Needed Services
- 1.Approaching Former Adult Client
- 2.Medical Marijuana
- 3.Pro Bono Work
- 4.Supervision Has Multiple Relationships with Family Receiving Services
- 5.Parent Training Concerns
- 6.Parents Not Implementing Procedures
- 7.Soliciting Parent Testimonials
- 8.Retaliation Towards Mandated Reporting
- 9.Family Rejecting Safety Measures
- 10.Parental Collaboration
- 11.Hostile Work Enviornment
- 12.Creating Protocol to Prevent and Treat Trauma with Limited Functional Language
- 13.Parent ABA Practice Questions in OT & Speech
- 14.Potential Gifts From Clients on Social Media
- 15.Helping Close Relationships With ABA Tips
- 16.Parent Utilizing CBD & THC
- 17.Client Pre-Authorization Denied For Much Needed Services
- 18.Supervisee Slaps Child in School Setting
- 19.Changing Direction of Treatment from Previous BCBA
- 20.BCBA Subpoenaed in Family Court
- 21.Terminate Services Due To Parent Behavior
- 22.Parents Offering Token Items During Check Out/Transition
- 23.Family Doesn’t Want Details Released To Funding Source Without Permission
- 24.Resources for IRB Approval for Independent Researchers
- 25.Speech Therapist Refusing To Do PECS
- 26.BCBA Receives Cease & Desist
- 27.Unlicensed, Certified BCBA Provide Supervision
- 28.Rapid Prompting Method (RPM)
- 29.Parent as Witness to Accident
- 30.Website Testimonials
- 31.Student Using Social Media Inappropriately
- 32.Hiring Behavior Analyst Trainees at a School District
- 33.College Recommendation Letter for Client
- 34.Connecting Families That Are Clients
- 35.Employer Requiring Same Number of ABA Hours for All New Clients from New BCaBA
Scenario
You receive an ABA referral from a pediatrician for a 3-year-old client; you call the parent listed and gather insurance details and enough background information to see if the client’s behaviors are within the scope of the practice. The client is severely impacted and engaging in high rates of SIB; your colleague that specializes in SIB has an opening on his caseload. When the team proceeds to obtain prior authorization from the client’s primary insurance, pre-auth is denied as there is no IQ score listed on the developmental pediatrician’s evaluation. Additionally, there is not a standard assessment included on the developmental pediatrician’s evaluation; an additional reason for the denial. The ABA team for the insurance company acknowledges the autism diagnosis on the report but state they cannot process the pre-authorization with the missing components. You explain the situation to the parent; he attempts to schedule another appointment with the pediatrician, but the next available appointment is in 9 weeks. The parent is extremely worried that the child might cause serious self-harm in the interim and is desperate for help. Does our code guide us in how to approach this situation? What are the ethical considerations?
Response
- 2.01 accepting clients- business decision pro-bono work
- Disseminating information to diagnosing physicians
- Setting up contract to provide consultation in the interim