Frequently Asked Questions
What is Autism?
Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication and behavioral challenges. People with ASDs handle information in their brain differently than other people. ASDs are "spectrum disorders." That means ASDs affect each person in different ways, and can range from very mild to severe. People with ASDs share some similar symptoms, such as problems with social interaction. But there are differences in when the symptoms start, how severe they are, and the exact nature of the symptoms.
There are three different types of ASDs:
Autistic Disorder (also called "classic" autism): This is what most people think of when hearing the word "autism." People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.
Asperger Syndrome: People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability.
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS; also called "atypical autism"): People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.
What are the symptoms of autism?
ASDs begin before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.
A person with an ASD might:
- Not respond to their name by 12 months
- Not point at objects to show interest (point at an airplane flying over) by 14 months
- Not play "pretend" games (pretend to "feed" a doll) by 18 months
- Avoid eye contact and want to be alone
- Have trouble understanding other people's feelings or talking about their own feelings
- Have delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- Give unrelated answers to questions
- Get upset by minor changes
- Have obsessive interests
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to the way things sound, smell, taste, look, or feel
Does TDLC only treat children with autism?
No, TDLC is able to help a variety of children with many different backgrounds, skill levels, and challenges. Since we are an ABA-based clinic, our main focus is to understand and modify problem behaviors, but since we have incorporated speech therapy, occupational therapy, and social skills classes into our program, we have a multi-dimenstional approach to treatment. We require an ASD report for authorization.
What is ABA (Applied Behavior Analysis)?
ABA, in its simplest terms, is the study and modification of behavior. It is a one-on-one therapy that involves the process of behavior modification in order to reduce unwanted behaviors and encourage appropriate and adaptive behaviors. It is the power of reinforcement that allows therapists to modify a behavior and teach new skills. ABA, in a structured environment, helps children acquire skills that typical children learn naturally. It is the most researched and supported therapy for helping children with special needs improve. Applied Behavior Analysis is the only scientifically proven way to treat children with Autism and other special needs, and it is easy to understand because it uses simple rules and procedures.
Do you diagnose children at your locations?
Currently, we do not diagnose children at our Learning Centers, but we are able to provide great referrals if requested.
What qualifications does your staff have?
We have a vigorous hiring process to ensure that we only hire therapists that have a true passion for working with your child. Most ABA therapists are college students or college graduates who are aiming to become behavior analysts, speech pathologists or special education teachers. They go through a comprehensive in-house training program, and gain lots of supervised hands-on experience before they work with your child. All our ABA therapists are RBT certified.
How soon can your services start?
Services begin after insurance is verified, your initial assessment is successfully completed, and we have obtained authorization for treatment if required. Therapy schedules are then planned to best fulfill your needs and matched with therapist availability.
What happens during the evaluation?
During the evaluation, the BCBA, MOT, and or SLP will greet you and take your child back to the assessment room while you wait in the lobby. Once the evaluation is complete, the therapist will return to the lobby to speak with you regarding the outcome of the evaluation. At this time, your child may be with another evaluator if your child is being evaluated for multiple services. After each evaluator is finished, they will come out and speak with you – the last person will bring your child out with him/her.
What happens after the evaluation?
Once the evaluation has been completed, your child may/may not require pre-authorization of services to start therapy. While we are waiting to see if insurance will approve prior authorization for services (if applicable), the Office Manager will call you to set up (a) potential start date(s). We strongly advise and encourage that a client’s start date coincide with his/her authorization date to ensure a smoother process with the insurance company and further authorizations throughout the year. However, we tend to start new clients on or around the 1st and 3rd Monday of the month.
TDLC schedules clients on a monthly basis. On the 25th of every month, you will be sent a calendar via email for the month following. Also, TDLC only schedules clients at the top of the hour on a daily basis. We do not schedule in 30 minute increments. For example, if requesting an 8:30a-4:30p schedule, we will only schedule at the tops of the hour, at 8a and 4p respectively.
How does TDLC determine placement for my child?
We typically split our clients into caseloads. Each caseload is overseen by a BCBA and a case manager. Some of the clients, depending on age and/or development, may switch caseloads over the course of treatment, as each caseload is focused on different ages and developmental levels. You will typically be notified via email and/or in person if/when you child may be moved to another BCBA’s caseload.
How does TDLC work with insurance companies to approve treatment hours for my child’s plan of care?
Some insurance companies only approve a certain amount of hours of treatment rather than the recommended hours set forth by the credentialed staff overseeing your child’s plan of care. For example, your insurance company may only approve 25 hours of ABA therapy rather than the BCBA’s recommended 35 hours. If this occurs, we will reduce the schedule to reflect the authorized amounts. However, if you would like to keep the same schedule you may be required to pay the remaining hours at TDLC’s self-pay rates. TDLC will go through an appeal process with the insurance company to see if they will cover the remaining recommended plan of care hours.
Are there out of pocket expenses for hours not covered by insurance?
Some insurance companies only approve a certain amount of hours, rather than the recommended hours set forth by the credentialed staff overseeing your child’s plan of care. For example, if your insurance company approves only 25 hours of ABA therapy, rather than the BCBA’s recommended 35 hours, you may be required to pay the remaining hours at TDLC’s self-pay rate. At this time, we will file an appeal with the insurance company to see if they will cover the remaining recommended plan of care hours.
*In our experience, it typically takes 3-4 weeks for an insurance company to approve or deny an appeal. While we are waiting to obtain an answer from insurance regarding the appeal, we must adjust your child’s schedule according to the initial approved hours by your insurance company.
If the appeal comes back approved, we will adjust your schedule to meet the recommended plan of care hours. If the appeal comes back DENIED, it will be up to the BCBA to determine if your child will still make adequate and quality progress with the hours that your insurance company will cover. IF the BCBA does not think your child will make progress with the amount of hours insurance is willing to cover, you will have a two week period to decide whether or not you want to proceed with paying the remaining hours at a self-pay rate.
If we do not hear from you within two weeks’ time as to your decision, we will automatically adjust your child’s schedule according to the recommended plan of care initially set forth by the BCBA and you will be charged the self-pay rate for the remaining hours not approved/covered by insurance.
Are there out of pocket expenses if I reach my limit for ST/OT services?
Many clients receive ABA/ST/OT services together. Some insurance companies only allow a certain number of visit limits for ST and/or OT per year. Oftentimes, we see visit limits run out towards the end of the year for clients that are receiving these therapy services. For example, if your ST and/or OT visits run out the beginning of November, you will be responsible for paying for any further visits out of pocket till the end of the year, should you choose this option. If you do not want to pay out of pocket for these services, then we MUST adjust your child’s schedule accordingly. This may mean that your child (if only receiving ST/OT) may not resume these services until the new year after insurance reverification. OR, if your child is also receiving ABA, we must adjust his/her schedule accordingly.
This means that we will have to reduce your child’s weekly schedule by however many hours they were receiving per week of ST and/or OT. For example, if your child is receiving 4 hours/week of ST and OT, then we will have to reduce his/her ABA schedule by 4 hours every week.
*TDLC will allow a 2 week ‘grace period’ once visit limits expire, where your child may continue services with their regular schedule without charge. However, within this 2 week ‘grace period’, you must decide whether or not you will move forward at a self-pay rate if desiring your child to continue ST and/or OT services. If we do not hear from you after this ‘grace period’, we will automatically adjust your schedule for ABA therapy services (if applicable), or discontinue ST/OT services until the new year after re-verification of benefits.
What happens if my re-verification of benefits is not covered?
Often times, we see this particular issue arise whenever re-verification of benefits takes place at the beginning of the year. If your child is currently attending our facility, your child may still continue therapy with their regular schedule until the new insurance policy takes effect at TDLC’s self-pay rate per type of service. The other option is to put your child’s services on hold until the new policy is approved. We will not reduce your child’s therapy hours – we must abide by the recommended plan of care hours.
If insurance limits my hours, can I spread those hours over 12 months?
We must follow the recommended plan of care, based on the evaluation and unfortunately, insurance companies will not allow for this.
What happens if I decide to extend my family's vacation time?
We typically see parents take a vacation around the summer or winter holidays. If any of your vacations will extend past 2 weeks from the dates you originally requested off, we will be happy to hold your child’s spot while he/she is away. However, if you plan to be gone longer than 2 weeks from the original requested dates, your child will start over in the intake process and services will stop immediately.
Can I transfer my child between your locations?
Yes, we are able to transfer clients across clinic locations, granted there is a spot available at that specific location. We do require a 30 day notice from you in writing if you want to transfer your child to another location and the Office Manager will be in contact with you to ensure a smooth transition.
How often do meetings occur with my child's therapist(s)?
TDLC provides opportunities for clients to meet and discuss their child’s therapy services with the individuals overseeing their plan of care. We conduct meetings in several ways, as indicated below:
- Upon scheduling a start date for services, TDLC will also schedule a 30 day parent meeting from the original start date. At this time, you are able to meet with your child’s therapist(s) and discuss some of the goals they’ve set forth, as well as any progress made in the first 30 days of treatment.
- Care Coordination Meetings
- Every quarter, you will be provided the opportunity to meet with the credentialed staff overseeing your child, pertaining to each service received. These meetings are scheduled online via a specific website that we will open to TDLC clients prior to the meeting.
- Optional monthly meetings based on a pre-determined schedule between yourself and the provider(BCBA/SLP/MOT) of each service your child is receiving.
- Discharge/Transition Meetings - Prior to your child’s discharge or transition out of services, we will provide a meeting time to discuss the process.
What if I decide to pull my child from TDLC services?
Similar to a transfer, we do require a written 30 day notice of discharge, should you decide to terminate services with us. On the last date of service, you will be required to review and sign a discharge form. Your final billing statement (if applicable) will be provided on your child’s last day or shortly thereafter.
If you would like to bring your child back to TDLC for services, you must pay any outstanding balance prior to re-enrolling and begin the intake process over again.