If your child does not have an autism diagnosis yet, or the diagnosis report is old, you may be wondering where to get an evaluation and whether your insurance will accept it. Hope Center offers diagnostic evaluations. This page explains who does them, how they differ from the ABA assessment, what insurers look for in a diagnosis, and what to ask us about timing and cost.
Does Hope Center do autism evaluations?
Yes. Hope Center offers diagnostic evaluations. They are performed by our clinical director, Aisha Albright-Jourdan, MSW, LCSW, BCBA, with a supervising licensed psychologist. Part of the process is questionnaires that parents complete online.
Our BCBAs do not diagnose. Their job is the ABA assessment that plans treatment, which is a separate step. Keeping the two clear matters, because insurers ask who made the diagnosis.
How is a diagnostic evaluation different from an ABA assessment?
| Diagnostic evaluation | ABA assessment | |
|---|---|---|
| Question it answers | Does my child meet criteria for autism? | What should ABA work on, and how? |
| Who does it at Hope Center | Our clinical director, with a supervising licensed psychologist | A BCBA |
| Parent part | Online diagnostic questionnaires, plus your information about your child | Caregiver interview and goals |
| What you get | A diagnostic result you can share with your plan and your child's doctors | A written report and treatment plan, reviewed by the clinical director before it goes to insurance |
| Length | Ask us on your first call | 2 to 4 hours, in one or two sessions, at home or at a center |
Our ABA assessments page explains the treatment-planning assessment in detail.
Why does the diagnosis matter for insurance?
Insurance-funded ABA usually requires a diagnosis of autism spectrum disorder or Down syndrome. Plans also care about the report itself: who wrote it, when, and what it shows. Some examples from payer policies:
- Cigna (Evernorth). Its ABA coverage policy asks for a confirmed autism diagnosis under DSM-5-TR made by a professional licensed to diagnose independently. The request must give the diagnostician's name, credentials, licensure and the date of diagnosis.
- UMR. Its ABA documentation form says IEPs and school evaluations are not acceptable as the only proof of diagnosis, and asks for current documentation if the diagnostic report is more than four years old.
- TRICARE. The Autism Care Demonstration requires an autism diagnosis from an approved provider. Its list includes primary care providers such as pediatricians and specialists such as doctoral clinical psychologists. A referral and pre-authorization are also required.
Because each plan sets its own rules, ask your plan, or ask us during your free benefits check, whether it will accept an evaluation done the way ours are. For the bigger picture of who can diagnose in Florida, read who can diagnose autism in Florida.
What happens during an evaluation?
Every evaluation is shaped by the child, so we explain the specific steps when you schedule. In general, an autism evaluation gathers information from you about your child's development and daily life, looks at how your child communicates, plays and relates to others, and compares what it finds with diagnostic criteria. At Hope Center, parent-completed online questionnaires are part of the process. Our guide to the online parent questionnaires explains how to answer them well. For a general walk-through, see what happens at an autism evaluation.
To prepare, gather:
- Any earlier reports: speech, occupational therapy, developmental screenings, school evaluations or an IEP.
- Notes on what you have noticed and when: first words, play, eye contact, routines, sensory reactions.
- Short videos of the things that worry you, if your child is comfortable being filmed.
- Both sides of every insurance card.
How long will it take, and what will it cost?
Ask us on your first call about scheduling and cost. Once you have finished all of the parent questionnaires, the report is usually ready within about a week. We can tell you what applies to you.
- Insurance. Florida's autism insurance law requires covered plans to include well-baby and well-child screening for diagnosing autism (Fla. Stat. 627.6686). Coverage for a full evaluation depends on your plan. If you use insurance, the clinical director's part of the evaluation is billed to your plan, not the whole evaluation, so ask us what you would pay for the rest. We work with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East (Humana Military). Optum: in network for mental health therapy; for ABA, call us for the current status.
- Self-pay. Self-pay is available for all of our services, with a sliding scale. If you pay yourself, you have a right to a Good Faith Estimate of expected charges, and we give you our fee schedule in writing before you start.
Self-pay ABA does not require a diagnosis, so if your child needs support now, you do not have to wait for the evaluation to finish to talk to us about ABA.
What happens after the diagnosis?
- If your child is diagnosed with autism, you can move straight into ABA intake if you choose: documents, a free benefits check, the BCBA's assessment, a treatment plan and insurance approval. See our intake timeline.
- If your plan needs a prescription for ABA, ask your child's doctor. Florida's mandate lets fully insured plans limit coverage to treatment prescribed by the treating physician under a treatment plan.
- If your child is not diagnosed with autism, the evaluation can still point you toward other help. ABA may still be possible through self-pay, and your child's doctor can advise on other referrals.
A diagnosis can bring relief, worry or both. All of those feelings are common.
Ready to ask about an evaluation?
Call 561-337-8865, email office@hopecenteraba.com or request a free consultation. Tell us your child's age, any reports you already have, your insurance and your location, and we will explain timing and next steps. Our new families page shows the whole path to starting ABA.