Insurance Requirements for Accepting CDE’s for Pre-Authorization for ABA Services

Educate Yourself on CDE Insurance Requirements

Parents and ABA providers, it is extremely important you educate yourselves on what exactly is needed in a comprehensive diagnostic evaluation (CDE) when looking for an examiner to conduct this important evaluation. Insurance companies, including all forms of Medicaid, require specific details in the document if they are going to approve ABA services for your child. Insurance providers also require a specific type of doctor to sign the report.

At Hart4Autism, Dr. Kerri Duncan has all the components included in her CDE’s, including an appropriately qualified doctor to sign the reports. Due to this, Dr. Kerri's reports have always been - and will continue to be - accepted as a true diagnosis according to insurance companies. With a signed CDE from Dr. Kerri, insurance will be able to approve the ABA therapy a child may desperately need.

Your insurance provider can provide you with a list of what specifically is required from them in a diagnosis. The most important thing to understand is that a diagnosis assessment is comprehensive, meaning more than one assessment is conducted. Dr. Kerri has unfortunately received many calls from parents who have found themselves rejected from insurance after months of waiting and paying out of pocket. An official CDE is not just the ADOS-2 Assessment. CDE reports include several additional assessments, including by not limited to:

• Childhood Autism Rating Scale

• Social Skills and/or Behavior Inventory

• Developmental History

• Vision Assessment

• Hearing Assessment

• Record Reviews

Once a CDE has been compiled, it must be signed by one of the following types of doctors:

• Developmental pediatrician

• Pediatric neurologist

• Licensed psychologist

• Child psychiatrist

  
  

Without one of the above specialists signature, the assessment will not be accepted and the family will have to start over with the entire process.

Seeking Out A CDE Assessment For Your Child

As with most things relating to insurance companies, the details are important as following the required process is a mandatory component of insurance approval. As a parent, if the doctor says, "I think your child may have autism," you do not want to waste time starting the process to have your child evaluated so services can be accessed more quickly. A comprehensive CDE must be obtained and signed off by an appropriate specialist before any services can be provided.

Doctors do not typically provide assessments in their office, but can refer you to a specialist. We suggest also doing your own research and calling around to find out your own information as well, considering the following factors:

Evaluation Type

Confirm what the assessment includes, ensuring they are comprehensive and in line with what your insurance company requires. Make sure the CDE will be signed by the correct type of doctor as outlined above.

Evaluation Cost

Ask upfront for complete pricing information, as evaluation costs can vary tremendously, ranging from $400 to $5,000. Hart4Autism is proud to offer fair and affordable pricing for our high-quality, professional services. Our full CDE pricing ranges from $725 to $850, depending on specific factors. Hart4Autism is also an approved provider through the Step-Up Scholarship Program, plus accepts Health Savings Account cards and credit cards. Single case agreements through Medicaid and other healthcare providers might also be possible.

Evaluation Timeline

Some families have had to wait months before they were able to schedule a diagnostic assessment. When you're looking for a company to work worth, be sure to find out how quickly you will be able to make an assessment for your child. Dr. Kerri or one of her esteemed colleagues can generally schedule an appointment for your child's assessment within two weeks of your call, with the report signed and ready for you within 3-4 business days.

Hart4Autism Provides Comprehensive CDEs Quickly & Affordably

Please make note of these requirements, checking with your insurance company to confirm any additional or specific components they may require. Knowing exactly what you need for insurance approval will help streamline the process to access much-needed services for your child more quickly.

Call Dr. Kerri today at 417-860-7640 to schedule your CDE and begin the process in your autism journey.