Prior Authorization for ABA: How to Get Approved and Get Paid (with Silna Health)

A family calls. They want to start ABA. And before a single session can happen, someone on your team has to answer one quiet question that turns out to be anything but simple. Is this patient actually clear to receive care today?Until the answer is yes, nothing else matters. Not the schedule, not the treatment plan, not the great clinician you just hired. And if the answer comes back wrong, you can render a month or two of care you may never get paid for.In this episode I sit down with Sagar Jajoo, co-founder and COO of Silna Health, the first care readiness platform in healthcare. Silna handles everything upstream of care. Prior authorizations, benefit checks, insurance discovery, and ongoing eligibility monitoring. Sagar came to this work honestly. His mom is an occupational therapist and his wife works in mental health, and he kept hearing the same thing. The hardest part of the job is fighting insurance to get paid for care you have already given.We get into the work that decides whether a session can happen and whether you collect on it:Why the upstream work (authorizations, benefits, eligibility) prevents denials at the source, instead of fighting them on the back end after the money is already lost.What ABA-specific benefit checks actually catch. School-setting and telehealth exclusions, self-funded plan gaps, and the cost estimate that lets a family know what care will cost before they start.The real price of a late or denied reauth, now that payers have gotten stricter about backdating and retroactive approvals.The payer-specific rules that quietly sink first-pass approvals. Graph axis labels in Georgia, school-based hours with Aetna, live phone reviews with Blue Cross in Illinois and Texas, a patient name required on every page in Nevada.Why payers are tightening at all. ABA's fast growth, fixed Medicaid budgets, and new scrutiny on the 40-hour model. How to read it with a little less frustration.How to tell a shiny demo from tech that actually helps. Interoperability, who owns the outcome when the AI fails, and how long it really takes to see value.Sagar's challenge to every owner. The 60-page SOP that was survival five years ago will not carry you in an AI-forward world where payers scrutinize every dollar.Learn more about Silna Health at https://www.silnahealth.comSilna CEO Jeff Morelli will be on stage at ABA C.A.R.E.S. in Boston this August for a panel called The Hidden Cost of Bad Tech. The Silna team will also have a booth, so you can bring your toughest prior auth questions in person. We'll see you in Boston August 4th through 7th, or live streaming from the other side of the screen.