The BCBA recommended 25 hours a week, but insurance approved 10. The clinic says this happens all the time. What should be in the appeal?
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Yes, you can appeal a partial approval. Ask the insurer for the criteria used to reduce hours. The appeal should include the assessment, treatment plan, specific goals, safety concerns if any, parent training needs, and data explaining why 10 hours will not meet the plan. The BCBA should write in the insurer's language and request a peer-to-peer review. Also ask what data they will need at the next authorization so you are not surprised again.
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