Can I Get Financial Assistance for Out-of-network Aba Therapy for my Child in Utah?
Yes, financial assistance and reimbursement for out-of-network ABA therapy are available in Utah, primarily through the state’s autism insurance mandate (SB195). This mandate requires private insurers to cover ABA therapy for individuals up to age 21, providing at least $50,000 in annual benefits for intensive services with no annual limits on therapy hours.
While out-of-network providers do not have direct contracts with insurance companies, their services are often eligible for partial or full reimbursement under this mandate. Common reimbursement rates for out-of-network services are typically between 60% and 80% of costs after the deductible is met, though some plans may reimburse as much as 70% to 90%.
To access this assistance, families typically follow these steps:
- Verify benefits with the insurer to confirm out-of-network reimbursement rates.
- Obtain a formal diagnosis of Autism Spectrum Disorder (ASD) and a letter of medical necessity from a licensed physician.
- Submit a detailed superbill provided by the BCBA to the insurance company.
Additionally, families may explore other financial resources such as Utah’s autism waivers for low-income support, Medicaid, or grants from non-profit organizations.
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