Start With Your Specific Plan
Coverage differs by payer, employer plan, Medicaid program, diagnosis, medical-necessity criteria, network status, and authorization rules. General information cannot confirm an individual family’s benefits.
Common Terms
- Verification of benefits: confirming plan information and general coverage
- Prior authorization: payer approval required before certain services
- Medical necessity: payer criteria used to determine whether requested services meet coverage requirements
- Deductible: amount a member may need to pay before certain plan benefits apply
- Copay/coinsurance: member cost-sharing that may apply
How The Dailey Institute Helps
During intake, our team verifies available benefits, identifies authorization requirements, and explains known next steps. Benefit verification is not a guarantee of payment because final coverage decisions are made by the payer.
North Carolina Resources
Families may also use official North Carolina Medicaid and their health plan’s member resources to understand eligibility, benefits, appeals, and member services.
Questions to Ask
- Is ABA covered under my plan?
- Is a referral or diagnostic documentation required?
- Is prior authorization required?
- Are there visit, hour, or network restrictions?
- What out-of-pocket costs may apply?
- What happens if my insurance changes?
Important Note
Insurance information changes and varies by plan. Individual benefits must be verified.
Next Step
Use the Insurance & Access page or contact our team to begin benefit verification.
