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Beyond Beginnings: Service Inquiry Form
If you are interested in our services, please complete the form below. Someone from our office will be in contact within 48-72 business hours.
Date of Inquiry
*
-
Month
-
Day
Year
Date
How did you hear about us?
Please Select
BTI (Current client, employee, etc.)
Physician
Insurance provider
Case Manager
Internet Search
Parent/Guardian Name
*
If submitting for yourself, please type N/A.
Client Name
*
Client Initials (e.g., Jane Doe=JaDo)
*
Client Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select the services you are seeking:
ASD Early Evaluation
Natural Environment Coaching
Bridge Services
Behavior or Speech Consultation
I'm not sure, please call me
Insurance & Payment
Beyond Beginnings participates with select insurance plans for eligible services. We currently accept Kansas Medicaid plans (UnitedHealthcare Community Plan, Healthy Blue, and Sunflower Health Plan) and Blue Cross and Blue Shield (BCBS). Please note: Autism Spectrum Disorder (ASD) diagnostic evaluations are not billed to insurance and are offered for a flat fee, self-pay basis only, regardless of insurance coverage. Insurance coverage and benefits vary by plan and service. Our team will review your information and discuss applicable coverage, authorization requirements, and payment options with you before services begin.
Please note that we do not accept insurance as a form of payment for ASD Evaluations. If requested, we will provide detailed invoices that you can submit to your insurance for reimbursement should you choose to do so. Please check below indicating understanding that we are a fee-for-service provider:
*
Yes, I understand
How do you anticipate paying for services?
Please Select
Kansas Medicaid – UnitedHealthcare
Kansas Medicaid – Healthy Blue
Kansas Medicaid – Sunflower Health
Blue Cross and Blue Shield (BCBS)
Self-pay
Unsure
Please describe the primary concerns and any additional information you'd like to share:
*
Submit
Should be Empty: