Insurance Verification

  • Intake

    1. Intake

    Use the following online form or click here to download our PDF intake form. If you need assistance, please email us at jlaudadio@gershabaservices.com.

  • Intake

    2. Authorization

    Our team will contact your insurance to determine your coverage for ABA services. Once we know that you are approved, a BCBA will be assigned to your case.

  • Intake

    3. Assessment

    In order to determine how many hours of ABA your child needs and develop a customized approach to their therapy, our BCBA will conduct an in depth assessment of your child.

  • Intake

    4. Approval

    After the assessment is submitted to your insurance carrier, your insurance will approve a specific number of hours of service per week for your child. PLEASE NOTE: This approval process can take up to 15 business days.

  • Intake

    5. Therapy

    Your BCBA will begin treatment on your child based on the determined schedule and therapy plan.

Insurance Intake

Use the following form to pre-qualify for Gersh ABA and a representative from our team will assist you in finding coverage.

Please fill out all sections of this form (as applicable). Required fields are marked with a ‘*’. Please call or email us if you require any assistance.

Tell us about you.

First Name
Last Name*
Phone
Mobile
Email*
Available Schedule

Address Information

Street
City
State
Country

Tell us about your child.

Child First Name
Child Last Name
Child Date of Birth
Child Gender
ASD Diagnosis*
Date of Evaluation
Diagnosing Doctor

Insurance Information

Type of Insurance
Insurance Company
Member ID
Policy Holder Name
Relation to Patient
Policy Holder DOB

Almost Done!

I agree to allow Gersh ABA Services to process my insurance for verification and billing purposes. *
Yes, keep me updated on Gersh news and events.
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IMPORTANT: Before we can verify your coverage with your insurance company, we need a copy of the front and back of your insurance card. Please scan or snap a picture of both sides and submit them via email to jlaudadio@gershabaservices.com along with your name and the day that you applied online. If you require assistance, please call us at 631-552-4600 or email us.
A quote of benefits and/or authorization does not guarantee payment. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. *** You will always be solely responsible for letting your provider know about any changes in insurance and or payment status for services. Any services not fully covered by insurance will be the responsibility of the patient/family.