Today we are highlighting an organization that operates behind the scenes. The CalABA – Active Health Insurance Practitioners (also known as Calahip, pronounce /cal- ə-hip/) is a subscription service sponsored by the California Association for Behavior Analysis (CalABA).

We recently spoke with Sarah Trautman-Eslinger, one of the key coordinators of Calahip and member of the CalABA Public Policy Committee about this new organization. She shed light on the organization, why it’s important and shared some suggestions for parents transitioning into insurance funding.

LMP: What is CalAHIP.org?

STE: CalAHIP is a subscription service sponsored by CalABA. The whole point of CalAHIP is to create a one-stop-shop for behavior analysts working in California to get information on how to successfully work with health insurance companies and health claims paid by their families.

LMP: What was the motivation behind creating this organization?

STE: Working with health insurance is really challenging and is a new skillset for all providers. We are moving from an educational or regional center model into a medical model (click here to read about the difference). Understanding how it works and interpreting policies takes time. At CalABA, there is a large brain trust of information. Our motivation was to go through and piece apart the components of these new policies and be specific about how this new thing works… for BCBAs who haven’t experienced it yet.

LMP: What would you recommend for parents who are switching from regional center services to insurance services?

STE: A few things come to mind. First, if a BCBA does not understand the system based on the implementation of SB 946, families may be forced to switch providers, which can result in a disruption of services. For a behavior analyst, getting credentialed is difficult, but insurance companies require credentialed providers. Insurance companies provide in-network applications and CalAHIP has a lot of information on how to get credentialed as an in-network provider.

Also, the errors that can arise from a billing error with insurance companies can be very costly to a business owner. At the regional center, you provide a service, and then receive payment either 15 or 30 days into the following month. With insurance payment, this takes at least 45 days and if an error in submission occurs, this can take even longer, taking a financial toll on a provider. An error such as this can make it almost impossible for them to continue providing services.

LMP: You bring up a great point – these companies have a great obligation to families they service. Why is it critical for providers to understand and mitigate issues that arise within the management of their practice, especially as these issues relate to working with health insurance companies?

STE: It is of great importance – a mismanagement of their practice can cause a major blow to families and would be highly disruptive. This is a great example of why every provider should understand practice management issues. Topics such as these will be discussed in our upcoming webinar. It’s important that claims be accurate. If you make a mistake, you won’t get paid. If services are not being rendered correctly, this can greatly impact families.

LMP: What can you share with parents about these transitions in funding to best navigate this system?

STE: The most important thing for parents to do is to understand their own health insurance policy. Is it regulated by the state of California or is it regulated by the Department of Labor (ERISA)? If it’s regulated by ERISA, then this policy is not subject to the California mandate. Medical or CalPERS is not either. Understand who your regulatory body is for your insurance plan.

Also, understand what the dates of the policy year are. For example, if a family has a $5,000 deductible starting January 1^st, come next January first that family will have to pay the $5,000 before insurance kicks in. This process will require collaboration between families, the regional center and insurance companies.

Most importantly, don’t panic! Resources like CalAHIP were created to help practitioners work with health insurance companies. We want as many options as possible for clients and their families. Be patient and diligent, this can be done successfully with some effort.

LMP: Thank you so much for taking the time to speak to us. We are excited about what this means for families and for the practitioners that serve them.

https://calabawebinars.webex.com/calabawebinars/onstage/g.php?t=a&d=667143607