Cost is one of the first things parents ask about, and one of the hardest to answer in general terms, because it depends on your plan, your deductible and how many hours your child needs. This page explains the two options Hope Center offers beyond standard insurance billing: our sliding scale and self-pay. It also explains, plainly, why we do not simply skip copays and deductibles, and what rights you have when you pay for care yourself.
Who is the sliding scale for?
Hope Center's sliding scale is designed to help families with the costs insurance leaves behind, especially deductibles and copays. ABA often involves many sessions a week, so a deductible or per-visit cost share can add up quickly, especially early in the plan year or on a high-deductible plan.
It can also help families who pay for services themselves. The sliding scale is based on household income and family size. You apply in writing and include income documents, we review your application, and an approval lasts up to 12 months. It applies to your share after insurance pays, and to self-pay. Ask us, and we will explain in writing what applies to you.
What does self-pay mean at Hope Center?
Self-pay means you pay Hope Center directly instead of billing a health plan. It is available for all of our services: ABA in a center, at home, at school or daycare and in the community; parent training; assessments; and mental health therapy.
Our self-pay rates are set by our fee schedule:
| Service | Self-pay rate |
|---|---|
| Initial assessment by the lead BCBA | $155 an hour |
| Board Certified Behavior Analyst (BCBA) | $130 an hour |
| Board Certified Assistant Behavior Analyst (BCaBA) | $125 an hour |
| Registered Behavior Technician (RBT) | $100 an hour |
| Group ABA | $75 an hour per child |
| Mental health therapy | $175 an hour |
| Family or couples therapy | $225 an hour |
Services are billed in 15-minute units, so your total depends on the hours in your child's plan, and the sliding scale can lower it. One exception to self-pay: a child who has Medicaid cannot be seen self-pay at Hope Center (center policy). Families with Medicaid can add employer or Marketplace insurance, which we accept, and use the sliding scale for their share.
Families choose self-pay for different reasons:
- No diagnosis yet. Insurance-funded ABA usually requires an autism or Down syndrome diagnosis. Self-pay does not, so you can start support while you wait for an evaluation.
- No ABA coverage. Some plans, such as many individual and small-employer plans, do not include ABA. Florida's autism mandate applies only to certain fully insured large-group plans, group HMOs and the state employee plan.
- A plan we do not work with. We work with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East. Optum: in network for mental health therapy; for ABA, call us for the current status.
- Services a plan will not cover. For example, a plan may exclude goals it considers educational.
- Privacy or flexibility. Some families prefer not to involve their insurer.
For how self-pay compares with insurance overall, see how much ABA costs without insurance.
Why doesn't Hope Center just skip my copay or deductible?
Some families ask whether we can bill insurance and simply not collect their share. We cannot do that as a routine practice, and you should be cautious of any provider who offers it.
Florida law treats it as insurance fraud for a service provider, other than a hospital, to have a general business practice of billing an insurer its usual charge while agreeing with the patient, or intending, not to collect the deductible or copayment, or otherwise not intending to collect the full charge (Fla. Stat. 817.234(7)(a)). Your plan's cost-sharing is part of the price your insurer agreed to; quietly dropping it changes that price without telling the insurer.
What we can do openly is offer our sliding scale, discuss payment arrangements, and explain your costs before you start. If you are facing financial hardship, tell us; it is a conversation, not a judgment.
How do I find out what I would pay?
- Free benefits check. Send us your insurance card. We contact your plan and find out whether ABA is covered, what prior authorization is needed, and your deductible, copay or coinsurance and out-of-pocket maximum.
- Plain-language explanation. We explain the results and what they likely mean month to month. Your actual cost depends on your plan and the hours your insurer approves.
- Sliding scale application. If your share is hard to manage, or you plan to self-pay, you can apply for the sliding scale in writing with income documents.
- Written estimate. If you will pay yourself, we give you our fee schedule and your child's recommended hours in writing before you start, as your Good Faith Estimate (see below). If you use insurance, you sign a benefits verification that shows your costs.
Read more about what happens during your benefits check.
What rights do I have when I pay for care myself?
Federal No Surprises Act rules protect uninsured and self-pay patients:
- If you are not using insurance, a provider must give you a Good Faith Estimate of expected charges if you ask for one, or when you schedule a service at least 3 business days ahead. If you ask before scheduling, it must arrive within 3 business days.
- If your bill ends up at least $400 more than the estimate, you can dispute it through the federal patient-provider dispute process. The bill must be dated within the last 120 calendar days, and there is a $25 administrative fee.
- Questions go to the No Surprises Help Desk at 1-800-985-3059.
See your right to a Good Faith Estimate.
Can I use an HSA or FSA?
Possibly. IRS Publication 502 does not name ABA, but it says you can include "amounts you pay for therapy received as medical treatment" in medical expenses. Therapy prescribed to treat a diagnosed condition generally fits that description, and HSA and FSA reimbursements follow the same definition of qualified medical expenses. Your plan administrator may ask for a letter of medical necessity, and self-pay services without a diagnosis may be harder to claim. Ask your plan administrator or a tax professional before you rely on it. See using an HSA or FSA for ABA.
Other ways families cover the cost
- A second look at your coverage. If your plan is self-funded or small-group, ask HR whether ABA is covered anyway; many plans cover it by choice.
- TRICARE. Military families may use the TRICARE Autism Care Demonstration, which has no yearly or lifetime caps on ABA; we work with TRICARE East.
- The FES-UA scholarship. Florida's Family Empowerment Scholarship for Students with Unique Abilities can pay for ABA from approved providers. Families can use FES-UA scholarship funds toward balances left after insurance, most often BCBA supervision and parent training. Call us to confirm for your child.
- Free state programs. Early Steps (under 3) has no family fees, and CARD offers free resource help.
Ready to talk about cost?
We would rather you know your numbers before your child's first session than be surprised later. Start with a free benefits check and a conversation about the sliding scale or self-pay. See insurance at Hope Center, contact us or call 561-337-8865.