TDLC Insurance Application Form

*We are not accepting Cigna at this time*

Disclaimer One:

This application will include a download for intake paperwork we require you to fill out in order to begin services with Tangible Difference Learning Center (TDLC), contingent upon a pre-screening phone call.

I hereby acknowledge that I have read, understand, and agree to comply with the information contained in Disclaimer One:*

Sign/Type your name


Disclaimer Two:

TDLC provides ABA, Speech, Occupational Therapy, and Social Skills Services for children ages 2-10. The amount of service(s) your child will need depends on the evaluation(s) performed by our credentialed staff. Your child may be recommended for (a) service(s) anywhere from 2-40 hours a week. The paperwork you will download and submit via email along with the online form you will complete, will assist TDLC in obtaining and verifying insurance coverage, as well as, determining if TDLC is a compatible match for your child.

Before we process your paperwork and verify insurance, someone from our Intake Department will contact you (within 3 business days) for the pre-screening phone call. TDLC will not proceed in processing your application without the pre-screening phone call being completed.

Below is a list of criteria, further explaining TDLC’s rules and guidelines for accepting clients:

1. TDLC is not equipped to work with children that have significant medical conditions.

2. Services for less than 6 months or while visiting town for a short time will not qualify. All clients must agree and abide by the recommended plan of care hours dictated by the credentialed staff at the time of the evaluation.

3. Consistent schedules are pertinent to your child(ren)’s treatment and progression at TDLC. We require parents to attend training and meetings with credentialed therapy staff to assist in carry-over in the home.

4. TDLC accepts clients between the ages of 2 and 9. If you choose to enroll your child at the age of 9, TDLC will discharge your child from services within 3 months of his/her 12th birthday. This will constitute a ‘transition’ program by the age of 10 or 11, as determined by the credentialed staff overseeing your child.

I hereby acknowledge that I have read, understand, and agree to comply with the information contained in Disclaimer One:*

Sign/Type your name


Length of Process Information

As soon as you have completed and submitted all required paperwork, it will be forwarded to our Medical Billing Department for verification and logging into our system.

If we have ALL of the required paperwork, it will take 3-5 business days to verify insurance if prior authorization is not required. If prior authorization is required for the evaluation, it can take up to 3 weeks, depending on the insurance company and their review of the authorization request.

Please keep in mind that if we have to contact your child’s physician(s) to obtain any required document that was missing from your submission, the verification process might take much longer depending on how quickly we receive a response from the physician.

After verification, you’ll receive an email explaining your coverage and benefits offered by your health insurance plan for the service(s) you inquired and your application will then be routed to our Scheduling department. Someone from the Scheduling Department will contact you as dates become available for evaluations. This process may take some time due to other clients scheduled ahead of you. A representative from TDLC will contact you every 10-14 business days to update you on the status of your evaluation date.

Once the initial evaluation has been scheduled and completed, please allow time for preparation of the report and obtaining prior authorization for service if required by your health insurance plan. As soon as the prior approval of service is received, our Scheduler will contact you to set up a “start” date. Again, this may take some time due to clients scheduled ahead of you. A representative from TDLC will continue to contact you every 10-14 business days to update you on the status of your start date.

Application Checklist

Please download the required paperwork here Insurance Application Checklist

We have supplied a check list on this page as well as in your downloaded packet to help ensure you have everything completed prior to submitting.

As previously mentioned, any missing documentation can delay the process of verifying your insurance and therefore starting service(s) for your child.

The completed packet and required medical records can be emailed to director@tangibledifference.com with ATTN: Intake Department.

Thank you again for choosing Tangible Difference Learning Center to provide service(s) for your child(ren). We look forward to working with you and your family!