You have the diagnosis: Now what?

Receiving an autism spectrum disorder diagnosis brings to light an array of feelings for parents. One of the biggest questions after the diagnosis sinks in, is what do I do now? This will give you an outline of what steps need to be taken. Rest assured that you are not alone, someone can help you every step of the way.

1. Determining if your child will receive services funded through your insurance or Medicaid:

To do this you can either call your insurance company your self and ask them if ABA autism therapy services are a covered benefit or you can fill out a form and we will call for you. Typically insurance companies that are self- funded do not have to follow the insurance mandate, but there are several companies that do cover services. Almost all fully insured plans must follow the WI state mandate to cover ABA services. If insurance will fund autism treatment, we will guide you through getting started, it is fairly simple. An autism diagnosis is required, a prescription form needs to be filled out by the child’s primary doctor stating they feel autism services would benefit the child and your child’s senior therapist needs to write up a treatment plan. Once those things are done, therapy can get started. If your child is not eligible to receive services through insurance, your child could be funded through Wisconsin Medicaid. To get started with the Medicaid application process, please see #’s 2-7.

2. Does your child already have a forward health card?

If so, you can get started right away with submitting a prior authorization (which we will do for you). Once that is approved, therapy can start.

3. If your child does not have a forward health card, you can start the process of seeing if your child qualifies. A person can access Medicaid, which in turn gets you a forward health card by one of the following 3 methods:

BadgerCare Plus:

This is usually an income- based program

A disability determination is not needed

A co pay or deductible may apply

Social Security (SSI):

This is an income -based program

No co pay or deductible

A disability determination is required

Members can do a phone interview to see if they meet the income requirements

Katie Beckett:

This is not an income-based program

No co pay or deductible

A disability determination is required

Call: for Outagamie, Calumet, Brown counties call Heidi at 920-593-4311 For Winnebago, Fond Du Lac, Green Lake, Waupaca, Shawano, and Waushara call Laurie at 920-470-0726.

3. Establishing yourself with a provider:

Once you have a funding source, you will need to identify a provider, such as us, to work with. A senior therapist will come and meet with you to discuss programming and goals for your child. Your senior therapist will be your primary contact person. Your therapy team will consist of the following: a lead therapist/ Licensed Treatment Supervisor , a senior therapist/ Behavioral Treatment Therapist and line therapists/ behavior treatment technicians. A lead therapist is someone with a PhD or BCBA (Board Certified Behavior Analyst), who will come to your house on a bi-monthly basis to observe therapy, participate in a team meeting to talk about concerns that might arise, offer suggestions and supervise your senior therapist. Your senior therapist is someone who has a minimum of a Bachelor’s Degree in psychology or a related field and a minimum of 2000 hours experience working with children on the autism spectrum. Your senior therapist will write up goals for your child, be an advocate for you and your child, hire, train and supervise line therapists, attend school meetings, and oversee your child’s direct therapy. Your team of line therapists will include approximately 2-4 therapists who are typically college students majoring in a related field. Line therapists work 1:1 with your child on the goals set forth by the senior therapist.

The kind of care that makes a difference.