FAQs

Are you In-Network with my insurance?

We are contracted with: HPN/Sierra, Hometown Health, Prominence, NV Medicaid (fee for service), and HPN Medicaid. We are also contracted with ATAP.

If a provider is Out-of-Network with our primary insurance, but In-Network with our Secondary Insurance, is it possible to just ignore the Primary and bill the Secondary?

NO. This would be considered insurance fraud. You are obligated to report ALL policies to ALL providers so that the plans can be billed in the proper order. 

What if we add a new policy after services have begun? When should we report this to you?

Immediately. Ideally, you should discuss any possible insurance changes with any specialist that you currently receive services from well BEFORE any change goes into effect, so that they can let you know how it will affect your coverage. Remember, you might think that you are adding “back-up” insurance, when, in fact, you are switching your primary insurance. Additionally, even if you are only adding a secondary policy, and even if we are in-network with that payer, that policy will likely require prior authorization for ABA services, and that process takes time.

If you fail to report policy changes, before they go into effect, this may not be discovered for months (once the insurance plan starts denying based on their Coordination of Benefits information) which would then make you financially responsible for any charges incurred that insurance will not reimburse.

My insurance policy covers ABA, why won’t you accept it?

Most people do not realize that providers cannot simply choose to accept an insurance policy. Being In-Network requires a mutual existing agreement between the provider and the insurance company. Sometimes providers choose not to work with certain insurance companies, but it is also often the case that insurance companies will refuse to contract with providers. These In-Network agreements also take a long time to go into effect, which means that even if a provider is willing to attempt to go in network, in order to work with you, they might not be able to or the process could take up to 2 years to complete.

My insurance policy covers ABA, but none of the local providers accept my insurance! What can I do?

In cases like this, you can pursue something called an SCA (Single Case Agreement). This is a contract between the provider and the insurance company for a single case (that of your child). If an SCA is established a provider will be treated as if they were In-Network for the purposes of the single case, even though they are not In-Network. This is not always possible, but is worth considering if there are not good, readily available, in-network options. As there is a provider shortage in northern Nevada, there is often a good argument for “network inadequacy.” While providers can request an SCA, having the parent advocate for one, is often more successful. Please note, an SCA request may be turned down if the insurance company identifies an available In-Network provider. It is always recommended that you research In-Network providers, in advance of placing an SCA request, so that you can explain why you need to work with a provider outside of the existing provider network (availability, approach, setting, specialization, etc).