Does Insurance Cover ABA Therapy in Utah? Complete 2026 Insurance Breakdown

Yes! Insurance covers ABA therapy in Utah—and in 2026, Utah families have more comprehensive coverage than ever before. Thanks to progressive legislation passed over the past decade, most Utah insurance plans are required to cover Applied Behavior Analysis (ABA) therapy for autism spectrum disorder without age limits or hourly caps.

But understanding exactly what your insurance covers, how to access benefits, and what out-of-pocket costs you might face can still feel overwhelming. This comprehensive guide breaks down everything Utah families need to know about ABA therapy insurance coverage, from state mandates to Medicaid benefits, and provides a step-by-step roadmap to maximizing your insurance benefits.

Utah's ABA Insurance Coverage at a Glance: Since January 1, 2020, Utah law requires most insurance plans to cover ABA therapy with NO age limits, NO hourly caps, and 100% medically necessary coverage.

The Quick Answer: Does My Insurance Cover ABA Therapy in Utah?

Here's what you need to know immediately:

Most Likely YES if you have:

Utah Medicaid (all ages with autism diagnosis)
Individual health insurance plan purchased in Utah
Fully-insured large group employer plan (most small to mid-size companies)
Plans from Select Health, BCBS of Utah, Regence, or UnitedHealthcare

Possibly NO or Limited Coverage if you have: Self-funded employer plan (common with large corporations), Federal employee health plan (FEHB), Tricare or certain military plans (though Tricare does cover ABA), or health sharing ministries or alternative coverage arrangements.

The Bottom Line: Utah law mandates ABA coverage for most insurance plans, but not all. The key question is whether your plan is "state-regulated" (must follow Utah law) or "federally-regulated" (doesn't have to follow state mandates).

Understanding Utah's Autism Insurance Mandate

Utah's autism insurance mandate is codified in Utah Code § 31A-22-642, which requires health insurance plans to provide coverage for the diagnosis and treatment of autism spectrum disorder.

What the Law Requires

Coverage Must Include:

Diagnostic Evaluations: Assessments to diagnose autism spectrum disorder
ABA Therapy: Applied Behavior Analysis services supervised by qualified professionals (BCBAs)
Related Autism Treatments: Other medically necessary treatments for autism
No Age Discrimination: Coverage for individuals of any age (children and adults)
No Arbitrary Hour Limits: No annual or lifetime caps on therapy hours when medically necessary

Who Must Provide Coverage

Utah's mandate applies to:

Individual health insurance plans sold in Utah
Small group plans (employers with 2-50 employees)
Large group plans that are fully-insured (carrier takes the financial risk)

Key Qualifiers

To qualify for mandated coverage:

Individual must have a formal autism spectrum disorder diagnosis
Services must be deemed medically necessary by a qualified professional
Treatment must be provided by licensed, qualified providers
Services must follow evidence-based practices

How Utah's Insurance Law Evolved (2014-2026)

Understanding the history of Utah's autism insurance mandate helps explain why coverage is structured the way it is today.

2014 - Original Mandate (SB 57)

Utah passed its first autism insurance mandate requiring coverage for autism diagnosis and treatment. However, this initial law was quite restrictive:

Coverage limited to children ages 2-10 only
600-hour annual cap on ABA therapy (approximately 11.5 hours per week)
$1,000 monthly maximum benefit
Insurance commissioner could waive requirements if premiums increased more than 1%

Impact: While groundbreaking, these limitations left many families—particularly those with teenagers, adults, or children needing intensive services—without adequate coverage.

2019 - Major Expansion (SB 95)

Utah legislature passed Senate Bill 95, dramatically expanding coverage effective January 1, 2020:

Eliminated age caps: Coverage now available for individuals of any age
Removed hourly limits: No more 600-hour annual cap
Removed monthly maximums: No more $1,000 monthly cap
Eliminated waiver provision: Insurance commissioner can no longer waive requirements based on premium increases

Impact: This made Utah one of the most comprehensive autism insurance coverage states in the nation, allowing for truly intensive ABA therapy when medically necessary.

2023 - Adult Medicaid Coverage (SB 204)

Utah passed additional legislation ensuring adults with autism could access ABA services through Medicaid:

Removed age restrictions from Utah Medicaid autism services
Effective July 1, 2023
Ensured compliance between private insurance mandate and Medicaid coverage

Impact: Adults with autism gaining or maintaining Medicaid coverage no longer face service termination based on age.

2026 - Current Status

Today, Utah maintains comprehensive autism insurance coverage requirements:

All age groups covered under both private insurance and Medicaid
No hour or dollar limits for medically necessary services
Growing network of qualified ABA providers accepting insurance
Increased awareness among families about their coverage rights

Which Insurance Plans Must Cover ABA Therapy?

Not all health insurance plans are required to follow Utah's autism coverage mandate. Here's how to determine if your plan must provide ABA coverage:

Plans That MUST Cover ABA Therapy

Individual Plans: Any health insurance plan purchased directly by an individual or family in Utah - Coverage Required

Small Group Plans (2-50 employees): Employer-sponsored plans for small businesses, whether fully-insured or self-funded - Coverage Required

Fully-Insured Large Group Plans: Employer plans where the insurance company assumes the financial risk - Coverage Required

Utah Medicaid: All ages with autism diagnosis; comprehensive coverage with no caps - Coverage Required

CHIP (Children's Health Insurance Program): Federal program administered by Utah; covers medically necessary ABA - Coverage Required

Plans That May NOT Be Required to Cover

Self-Funded Employer Plans (ERISA): Large employers who self-insure are exempt from state mandates but may still provide coverage voluntarily

Federal Employee Plans (FEHB): Regulated by federal government, not state law; coverage varies by specific plan

Grandfathered Plans: Plans that existed before Affordable Care Act (rare); may have different requirements

Health Sharing Ministries: Not considered insurance; coverage for autism services varies widely

How to Determine If Your Plan Is Self-Funded (ERISA)

Self-funded plans are exempt from state insurance mandates. Here's how to find out if your employer plan is self-funded:

Check Your Summary Plan Description (SPD): This document must state whether the plan is self-funded or fully-insured. Look for phrases like "self-insured" or "self-funded."
Ask Your HR Department: They should be able to tell you immediately whether your plan is self-funded.
Look at Your Insurance Card: If it says "administered by" rather than "insured by," it's likely self-funded.
Contact Member Services: Call the number on your insurance card and ask directly.

Important: Even if your employer plan is self-funded and not legally required to cover ABA therapy, many choose to include autism coverage anyway. Always verify your specific plan's benefits rather than assuming coverage is not available.

Utah Medicaid Coverage Explained

Utah Medicaid provides some of the most comprehensive ABA therapy coverage available. Here's everything you need to know:

Who Qualifies for Utah Medicaid ABA Coverage

Eligibility Requirements:

Medicaid Enrollment: Individual must be enrolled in Utah Medicaid
Autism Diagnosis: Formal ASD diagnosis from qualified professional (psychologist, psychiatrist, or developmental pediatrician)
Medical Necessity: Services must be deemed medically necessary
Age: All ages covered (children, teens, and adults)

Utah Medicaid Programs Covering ABA

1. Traditional Medicaid (CHEC Program)

The Child Health Evaluation and Care (CHEC) program provides comprehensive healthcare for Medicaid-enrolled children up to age 21.

Covers diagnostic evaluations and ABA therapy
No hourly or dollar caps
Services delivered by Medicaid-enrolled providers
Requires prior authorization

2. Adult Medicaid Coverage

As of July 1, 2023, adults with autism can access ABA services through Utah Medicaid.

Available for adults 21+ with autism diagnosis
Same comprehensive coverage as children
Focus on maintaining skills and community integration

What Medicaid Covers

Utah Medicaid ABA coverage includes:

Comprehensive Assessment: Initial functional behavior assessment by BCBA to develop treatment plan
Direct ABA Therapy: One-on-one therapy sessions with behavior technicians under BCBA supervision
BCBA Supervision: Ongoing oversight, program modification, and treatment plan updates
Parent Training: Education and coaching for families to implement strategies at home
Group Services: Social skills groups and other group-based interventions when appropriate
Multiple Settings: In-home, clinic-based, school, and community-based services

Medicaid Authorization Process

Obtain Diagnosis: Get formal ASD diagnosis from qualified provider
Get Prescription: Physician or psychologist provides written prescription for ABA services
Select Provider: Choose Medicaid-enrolled ABA provider from official list
Initial Assessment: Provider conducts comprehensive assessment
Submit for Authorization: Provider submits treatment plan to Medicaid for prior authorization
Begin Services: Once approved, therapy begins per authorized plan
Ongoing Reauthorization: Typically required every 6 months with progress documentation

Medicaid Coverage Advantages

Why Medicaid Coverage Is Excellent for ABA:

No Out-of-Pocket Costs: Zero copays, deductibles, or coinsurance for members
No Hour Caps: Coverage continues as long as services are medically necessary
No Annual Maximums: No dollar limits on coverage
Comprehensive Service Array: Covers all aspects of ABA including parent training
Multiple Service Settings: Flexibility in where services are delivered
Carve-Out Service: Even if enrolled in a Medicaid managed care plan, ABA is billed directly to fee-for-service Medicaid

Important Medicaid Considerations

Key Points to Remember: Provider must be enrolled with Utah Medicaid (not all ABA providers accept Medicaid). If you have other insurance, it must be exhausted first (coordination of benefits). Services require prior authorization and regular reauthorization. Medical necessity must be demonstrated and maintained. Provider cannot bill you for services covered by Medicaid.

Major Private Insurance Providers in Utah

Here's what you need to know about ABA coverage from Utah's major private insurance companies:

Select Health

Coverage: Required under Utah mandate for state-regulated plans

Key Details:

Prior authorization required
Must use in-network providers for full benefits
No age or hour limits for medically necessary services
Out-of-pocket costs vary by specific plan (deductible, coinsurance, copays)
Large network of contracted ABA providers in Utah

Contact: Call member services or visit selecthealth.org

Blue Cross Blue Shield of Utah (BCBS)

Coverage: Required under Utah mandate for state-regulated plans

Key Details:

Comprehensive ABA coverage with no hour caps
Prior authorization process through behavioral health department
In-network vs. out-of-network benefits vary significantly
Self-funded employer plans may have different coverage
Growing provider network across Utah

Contact: 800-753-4621 or bcbsut.com

Regence BlueCross BlueShield

Coverage: Required under Utah mandate for state-regulated plans

Key Details:

ABA therapy covered as medically necessary treatment
Requires formal autism diagnosis
Treatment plan must be developed by BCBA
Regular progress reviews required for continued authorization

Contact: Call number on insurance card

UnitedHealthcare / Optum

Coverage: Varies significantly by plan type

Key Details:

Many UHC plans are self-funded and not subject to state mandate
However, many still provide autism coverage voluntarily
Behavioral health managed through Optum
Must verify specific plan benefits
National provider network

Contact: 866-314-5841 or uhc.com

EMI Health

Coverage: Provides ABA coverage for most plans

Key Details:

Utah-based non-profit health plan
Covers ABA therapy for autism diagnosis
Prior authorization required
Growing acceptance among Utah ABA providers

Contact: 800-662-5850 or emihealth.com

PEHP (Public Employees Health Program)

Coverage: Comprehensive autism coverage

Key Details:

Covers Utah state and local government employees
Excellent autism benefits with no hour caps
Well-known among Utah ABA providers
Streamlined authorization process

Contact: 801-366-7555 or pehp.org

University of Utah Health Plans (UUHP)

Coverage: Comprehensive ABA coverage

Key Details:

Covers University of Utah employees and others
Good network of providers
Prior authorization required

Contact: 801-587-6480 or uuhealthplans.utah.edu

What ABA Therapy Services Are Covered?

Understanding exactly which services your insurance covers helps you maximize benefits and avoid surprises.

Covered Services

1. Functional Behavior Assessment (FBA)

Comprehensive evaluation by BCBA
Identifies strengths, challenges, and treatment needs
Develops individualized treatment goals
Typically covered for initial assessment and periodic reassessments

2. Direct ABA Therapy (One-on-One)

Individual therapy sessions with behavior technician or RBT
Implementation of teaching strategies and interventions
Skill-building activities across developmental domains
Data collection during every session

3. BCBA Supervision and Program Modification

Ongoing clinical oversight by Board Certified Behavior Analyst
Regular observation and supervision of technicians
Data analysis and treatment plan adjustments
Coordination with other providers and school
Typically requires minimum 2-4 hours per month

4. Parent and Caregiver Training

Teaching families to implement ABA strategies
Skill generalization to home environment
Behavior management coaching
Helps maintain progress between therapy sessions

5. Group Social Skills Training

Small group interventions for social skill development
Peer interaction opportunities
Structured play and social coaching
May be covered when clinically appropriate

Service Settings Typically Covered

In-Home: Usually covered when deemed appropriate environment for treatment goals

Clinic/Center-Based: Most insurances cover services at licensed ABA centers

Community-Based: Usually covered when medically necessary for generalization of skills

School-Based: Complex - usually only if billed as medical treatment, not educational service

Telehealth: Covered for parent training, supervision; some direct services

What's Typically NOT Covered

Educational Services: Services designed to meet educational (not medical) needs typically fall under school district responsibility via IDEA
Respite Care: Childcare or supervision without therapeutic intervention
Experimental Treatments: Non-evidence-based interventions
Services Without Medical Necessity: Convenience services not tied to treatment goals
Services from Non-Qualified Providers: Therapy from providers without proper credentials

The Insurance Authorization Process: Step-by-Step

Getting insurance authorization for ABA therapy involves multiple steps. Here's exactly what to expect:

Step 1: Obtain Autism Diagnosis

You need a formal ASD diagnosis from a qualified professional (psychologist, psychiatrist, or developmental pediatrician). This diagnosis must use standardized assessment tools like ADOS-2 (Autism Diagnostic Observation Schedule), ADI-R (Autism Diagnostic Interview-Revised), Childhood Autism Rating Scale (CARS), or clinical evaluation and diagnostic report.

Timeline: Diagnostic evaluation typically takes 2-4 hours plus report writing (1-2 weeks)

Step 2: Get Prescription for ABA Services

Most insurances require a written prescription from your child's physician (pediatrician, developmental pediatrician, or psychiatrist) stating that ABA therapy is medically necessary.

Timeline: Usually immediate to 1 week depending on doctor's availability

Step 3: Choose an ABA Provider

Select a provider who is in-network with your insurance (when possible), has availability and serves your geographic area, has experience with your child's age and needs, and is properly credentialed and licensed.

Timeline: 1-2 weeks of research and consultations

Step 4: Complete Intake and Assessment

The ABA provider will complete intake paperwork and insurance verification, conduct comprehensive functional behavior assessment, develop individualized treatment plan with specific, measurable goals, and recommend appropriate number of therapy hours per week.

Timeline: 1-2 weeks from first contact to completed assessment

Step 5: Submit Authorization Request to Insurance

Your ABA provider submits a detailed authorization request including autism diagnosis documentation, physician prescription, assessment results and clinical rationale, treatment plan with specific goals, recommended frequency and duration of services, and provider credentials.

Timeline: Insurance review typically takes 2-4 weeks

Step 6: Receive Authorization Decision

Insurance will either approve (authorize specific number of hours for specific time period, typically 3-6 months), request more information (may ask for additional documentation), or deny (provide reason for denial which can be appealed).

Timeline: Decision communicated within 14-30 days of complete submission

Step 7: Begin ABA Therapy Services

Once authorized, therapy sessions begin per approved schedule, data is collected during every session, regular BCBA supervision and progress monitoring occurs, and parent training is incorporated into the program.

Timeline: Services typically start within 1-2 weeks of authorization

Step 8: Ongoing Reauthorization

Most authorizations require periodic renewal where the provider submits progress reports and updated treatment plans, demonstrates continued medical necessity, and adjusts goals and intensity as needed, typically every 3-6 months.

Timeline: Ongoing throughout treatment

Total Timeline Summary

From Diagnosis to Starting Therapy:

Diagnosis: 2-4 weeks
Provider selection and assessment: 2-3 weeks
Insurance authorization: 2-4 weeks
Scheduling and start: 1-2 weeks
Total: Typically 7-13 weeks (2-3 months)

This timeline can be shorter if you have all documentation ready or longer if there are delays in any step.

Understanding Your Out-of-Pocket Costs

Even with insurance coverage, you'll likely have some out-of-pocket expenses. Here's what to expect:

Common Out-of-Pocket Costs

Deductible: Amount you pay before insurance starts covering services. Annual deductibles typically range from $500-$5,000+ depending on your plan.

Copay: Fixed amount per visit (e.g., $20-$50 per therapy session). Some plans charge per session, others per day of service.

Coinsurance: Percentage you pay after deductible (e.g., 20% of allowed amount). Can result in significant costs for intensive services.

Out-of-Pocket Maximum: Once you reach this annual limit (typically $3,000-$9,000), insurance pays 100%. Important safety net for intensive therapy.

Sample Cost Scenarios

Scenario 1: Medicaid Coverage

Deductible: $0
Copay: $0
Coinsurance: $0
Your Cost: $0 per month

Scenario 2: Excellent Private Insurance

Deductible: $1,000 (paid once per year)
Copay: $25 per therapy session (4 sessions/week = $400/month)
Annual out-of-pocket max: $3,000
Your Cost: First few months higher, then $0 after hitting maximum

Scenario 3: High-Deductible Plan

Deductible: $5,000
Coinsurance: 20% after deductible
Out-of-pocket max: $7,000
Your Cost: Significant initial costs until deductible met, then 20% of services until out-of-pocket max reached

Strategies to Manage Costs

Choose In-Network Providers: Dramatically reduces out-of-pocket costs
Understand Your Out-of-Pocket Maximum: Once reached, all covered services are free
Coordinate Benefits: If you have multiple insurance policies, maximize both
Apply for Financial Assistance: Some providers offer sliding scale or financial assistance programs
Use Health Savings Account (HSA): Pay with pre-tax dollars if you have HSA-eligible plan
Investigate Autism-Specific Grants: Organizations like Autism Speaks, United Healthcare Children's Foundation, and others offer grants

Maximizing Your Insurance Benefits

Use these strategies to get the most from your ABA therapy insurance coverage:

1. Verify Benefits Before Starting

Call your insurance and ask specific questions: "Does my plan cover ABA therapy for autism?", "What are my deductible, copay, and coinsurance for ABA services?", "Is there an annual or lifetime limit on ABA therapy?", "Do I need prior authorization?", "What is the reauthorization frequency?", "Are there specific CPT codes I should be aware of?"

2. Stay In-Network When Possible

In-network providers have contracted rates with your insurance, resulting in lower out-of-pocket costs, easier authorization process, provider handles billing directly, and no balance billing.

3. Keep Detailed Records

Track all authorizations and their expiration dates
Save all Explanation of Benefits (EOB) statements
Document all phone calls with insurance (date, time, representative name, reference number)
Keep copies of all submitted documentation

4. Request Medical Necessity Letters

Have your BCBA provide detailed documentation of why the recommended intensity is necessary, expected outcomes without treatment, progress made with current treatment, and specific deficits being addressed.

5. Coordinate Benefits If You Have Multiple Coverage

If you and your spouse both have insurance that covers your child, one plan is "primary" and one is "secondary". Primary pays first, secondary may cover remaining costs. This can significantly reduce out-of-pocket expenses but requires careful coordination between providers and insurances.

6. Submit Reauthorizations Early

Start reauthorization process 30-45 days before current authorization expires
Prevents gaps in service
Allows time to appeal if denied

7. Understand Medical Necessity Requirements

Insurance covers services that are "medically necessary," meaning appropriate to treat diagnosed condition, based on evidence-based standards, expected to make measurable improvement, and not primarily for convenience or educational purposes.

What to Do If Coverage Is Denied

If your insurance denies coverage for ABA therapy, don't give up. Many denials can be successfully appealed.

Common Reasons for Denial

Not Medically Necessary: Insurance questions whether services meet medical necessity criteria
Experimental/Investigational: Incorrectly categorizing ABA as experimental (it's not)
Out-of-Network Provider: Services from non-contracted providers
Incomplete Documentation: Missing diagnosis, prescription, or other required paperwork
Administrative Error: Wrong codes, eligibility issues, or processing mistakes
Plan Exclusion: Plan specifically excludes autism services (self-funded plans)

The Appeals Process

Step 1: Request Written Denial

Get the denial in writing with specific reason for denial, citing relevant policy language.

Step 2: Review Your Policy

Read your insurance policy's autism coverage provisions. Look for what conditions trigger coverage, any exclusions or limitations, and appeal rights and procedures.

Step 3: Gather Supporting Documentation

Compile comprehensive evidence including formal autism diagnosis report, physician prescription and letter of medical necessity, BCBA's detailed treatment plan and rationale, research showing ABA effectiveness, Utah law (if applicable to your plan), and any progress data if continuing treatment.

Step 4: File Internal Appeal

Submit a formal written appeal to your insurance company including letter explaining why denial should be overturned, all supporting documentation, reference to Utah law if your plan is state-regulated, and request for expedited review if appropriate.

Timeline: Insurance must respond within 30 days (or 72 hours for expedited)

Step 5: File External Review (if Internal Appeal Denied)

Request independent external review by impartial third party. Available after exhausting internal appeals, typically no cost to you, reviewer is medical professional independent of your insurance, and decision is usually binding.

Step 6: File Complaint with Utah Insurance Department

If you believe the insurance company is violating Utah law, file complaint with Utah Insurance Department, provide all documentation, and the department investigates compliance with state mandates, which can result in enforcement action against insurance company.

Contact: Utah Insurance Department at 800-439-3805 or insurance.utah.gov

Getting Help with Appeals

Resources to assist with appeals:

Your ABA Provider: Often willing to write letters and provide documentation
Utah Parent Center: Provides assistance to families navigating insurance (utahparentcenter.org)
Autism Council of Utah: Offers resources and advocacy support
Legal Aid Organizations: Some offer free legal assistance for insurance appeals
Patient Advocates: Professionals who specialize in insurance appeals (may charge fee)

Success Rates: Insurance appeals are frequently successful, especially when supported by comprehensive medical documentation and clear evidence of medical necessity. Don't be discouraged by an initial denial—many families win on appeal.

Frequently Asked Questions

Does insurance cover ABA therapy for adults with autism in Utah?

Yes! As of 2020 for private insurance (SB 95) and July 2023 for Medicaid (SB 204), Utah no longer has age restrictions on ABA therapy coverage. Adults with autism can access ABA services when medically necessary through both private insurance (state-regulated plans) and Utah Medicaid.

How many hours of ABA therapy will insurance cover per week?

Utah law does not cap the number of hours. Coverage is based on medical necessity as determined by the BCBA and approved by insurance. Intensive programs typically range from 25-40 hours per week for young children, while focused interventions might be 10-25 hours weekly. The specific hours authorized depend on your child's individual needs and assessment results.

Can I use my insurance for ABA therapy in multiple settings?

Yes, most Utah insurance plans cover ABA therapy in various settings including home, clinic, and community when medically necessary. Medicaid explicitly allows multiple providers in different settings simultaneously. Check your specific plan, but flexible service delivery is generally supported.

What if my employer plan is self-funded? Do I have any recourse?

Even if your self-funded employer plan isn't required to follow Utah's mandate, many still provide autism coverage voluntarily. Check your Summary Plan Description (SPD) to see if ABA is covered. If not, you can advocate with your HR department to add coverage, explore Medicaid eligibility as secondary coverage, investigate autism-specific grants and financial assistance, or look into out-of-network benefits.

Do I need a new diagnosis if my child was diagnosed years ago?

Generally no. A formal autism diagnosis remains valid indefinitely. However, your insurance may require the diagnosis to be within a certain timeframe (often within past 12-24 months for new authorizations) or may request updated assessments to document current functioning level. Check with your insurance and ABA provider.

Can I get ABA therapy without an autism diagnosis?

No. Utah's insurance mandate specifically requires coverage for autism spectrum disorder. Private pay ABA services might be available without an autism diagnosis, but insurance coverage requires a formal ASD diagnosis from a qualified professional.

How long does ABA therapy coverage last?

There are no time limits on coverage in Utah as long as services remain medically necessary. Children can receive therapy for years if needed. Authorization periods are typically 3-6 months, requiring periodic reauthorization, but there's no maximum duration written into Utah law.

Will my insurance cover ABA therapy if we're traveling or temporarily in another state?

This depends on your specific plan. Many plans provide emergency out-of-network coverage but may not cover routine therapy out-of-state. Contact your insurance before traveling if you need to continue services. Some telehealth services might be available to maintain continuity.

What happens if my child's needs change and they need more or fewer hours?

Your BCBA can request authorization changes (increase or decrease) based on current assessment and medical necessity. Mid-authorization modifications are common as children progress or face new challenges. Insurance typically requires clinical justification for changes.

Conclusion: Your Path to Accessing ABA Therapy Coverage

Utah has made tremendous progress in ensuring insurance coverage for ABA therapy. Whether you have Medicaid, private insurance, or are navigating a complex employer plan, understanding your rights and the authorization process empowers you to access the services your child needs.

Key Takeaways

Utah law mandates comprehensive ABA coverage with NO age or hour limits for most plans
Utah Medicaid provides excellent coverage with zero out-of-pocket costs
Private insurance coverage depends on whether your plan is state-regulated or self-funded
The authorization process typically takes 2-4 weeks but requires multiple steps
Out-of-pocket costs vary widely by plan—understand your deductible, copay, and out-of-pocket maximum
Denials can often be successfully appealed with proper documentation
In-network providers significantly reduce costs and simplify the process
Keep detailed records and stay proactive about reauthorizations
Resources are available to help you navigate insurance challenges

Remember: You are not alone in navigating insurance for ABA therapy. Your ABA provider, advocacy organizations, and the Utah autism community are here to support you. With persistence and the right information, most Utah families can successfully access insurance coverage for ABA therapy.