Does my Health Insurance Plan Cover Aba Therapy in Utah?

In Utah, health insurance plans typically cover Applied Behavior Analysis (ABA) therapy due to state mandates such as SB 57 and SB 95. These laws require state-regulated plans, including individual and fully insured large group policies, to provide coverage for ABA with no age or dollar caps. Coverage is generally based on medical necessity and requires a formal autism diagnosis from a qualified professional.

Specific coverage options in Utah include:

• Private Insurance: Most private health plans include ABA services, though small group plans may have specific exclusions based on the employer.
• Utah Medicaid: Through the Children’s Health Evaluation and Treatment (CHEC) program, Medicaid provides coverage for eligible children under 21, often allowing up to 40 hours of therapy per week based on need.
• Tricare: Military families can access coverage through the Autism Care Demonstration for dependents under 21, typically offering up to 25 hours per week.

To secure coverage, families usually need to obtain prior authorization, submit a treatment plan developed by a Board Certified Behavior Analyst (BCBA), and confirm that their provider is in-network. Because benefits can vary, it is important to verify your specific policy details regarding copays and session limits.