Does Insurance Cover ABA Therapy in Utah?
Find out what Utah parents need to know about ABA coverage, from state rules to employer plans, plus the exact questions to ask.
How ABA Coverage Works in Utah
If you live in Utah and have a private health plan, your ABA coverage depends on one key thing: whether your plan is fully insured or self-funded. Utah has a state autism mandate, but it only applies to fully insured plans, the kind an insurance company sells directly to individuals or small groups.
Self-funded employer plans, where the employer pays claims directly, are governed by federal ERISA law, not state mandates. That means your employer can choose whether to cover ABA, and many do. This is why two families at the same company can get different answers: one might have a fully insured plan, the other self-funded.
Your plan documents will say which type you have. Your HR department or benefits administrator can tell you quickly.
Ask These Questions Before Calling an Agency
Before you pick up the phone to an ABA provider, get answers from your insurer or HR. This saves you from surprises later.
Ask exactly: "Is my plan fully insured or self-funded?" If self-funded, ask: "Does the plan cover ABA therapy for autism?" Then ask: "What are the specific coverage limits, like number of hours per week or total visits per year?"
Also ask: "Do I need a prior authorization, and what does it require?" and "What is my deductible, copay, and out-of-pocket maximum for ABA?"
- Plan type: fully insured or self-funded
- Coverage limits: hours, visits, or dollar caps
- Prior authorization requirements
- Costs: deductible, copay, out-of-pocket max
What Prior Authorization Needs
Most plans require prior authorization before ABA starts. That means your doctor or a specialist must submit a request to your insurer, who then approves or denies it.
Typically, you need a formal autism diagnosis, usually from a doctor or psychologist, and a treatment plan from the ABA provider. The plan may ask for specific forms, like a treatment plan request or a letter of medical necessity.
Start this process early. It can take a few weeks, and your ABA provider's billing team can help you gather the right paperwork.
What to Do If Your Claim Is Denied
If your insurer denies ABA coverage, don't give up. You have the right to appeal.
First, read the denial letter. It will state the reason and the deadline to appeal, often 60 days. Then, gather supporting documents: your child's diagnosis, treatment plan, and any letters from your doctor or ABA provider explaining why the therapy is medically necessary.
Submit the appeal in writing, and keep copies of everything. If the first appeal fails, you may have a second level of appeal, and in some cases, an external review by an independent party.
Utah Medicaid as an Option
If your income qualifies, Utah Medicaid may cover ABA therapy for children under 21. Medicaid covers medically necessary services, and ABA is often included for autism.
To apply, contact the Utah Department of Health and Human Services or visit their website. Your child's doctor or an ABA agency can also guide you.
If you're already on Medicaid, check with your managed care plan. The plan name is on your member card, and they can tell you which ABA providers are in network.
Finding ABA Providers in Utah
Once you know your coverage, you can start looking for an agency. In Utah, the listings for this state are spread across the counties we cover.
The largest concentrations are in Salt Lake County, Utah County, and Davis County. Other counties have fewer options, so you may need to travel or ask about telehealth services.
When you call, ask if they accept your insurance, if they have experience with your plan type, and if they can help with prior authorization.
Utah listings right now
194 ABA agencies across 14 Utah counties.