Unfortunately, there were no in-network ABA providers so his case manager set out to locate a high-value provider to establish a direct pay contract.
The first provider quoted a fee of nearly $400 per hour. However, since Mateo’s son would receive daily services, it would cost the company almost $100,000 per year.
The case manager located a second provider that also met our high quality standards. He was willing to accept a more reasonable rate of just over $75.00 per hour, which would save the company more than $81,000 per year compared to the first provider.
Another problem the case manager came across was the health plan had an annual limit of just over 60 visits for ABA. Because Mateo’s son needs daily services, he would meet his limit within a couple of months. To remedy this problem, the case manager collaborated with the company’s benefits consultant and TPA to modify the health plan to allow for more inclusive services. By doing so, Mateo’s son was able to receive services at the same level he had before.