What Insurance Covers In-home Aba Therapy for Autism in Utah?
In Utah, health insurance coverage for in-home Applied Behavior Analysis (ABA) therapy is governed by the Utah Insurance Code (Section 31A-22-642). Under this mandate, health plans are required to cover the diagnosis and treatment of autism spectrum disorder for children between the ages of two and ten. This coverage specifically includes ABA therapy provided by board-certified behavior analysts.
While state law mandates this coverage, families should keep the following details in mind regarding their insurance:
- Benefit Verification: It is necessary to verify specific coverage details, such as the number of weekly hours approved. For example, some families have successfully verified coverage for 20 weekly hours.
- Provider Requirements: To be eligible for coverage, the therapy must be provided by licensed professionals and a treatment plan must be submitted within 14 days.
- Financial Assistance: For costs not covered by private insurance, families may reduce their out-of-pocket expenses through Medicaid or specific grants.
- Professional Guidance: Many providers, such as Golden Touch ABA Therapy, offer assistance in navigating these benefits and confirming eligibility within a few days of intake.
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