Understanding ABA Insurance Coverage in Colorado
Navigating insurance coverage for ABA therapy can feel overwhelming. This guide covers the basics of what Colorado families should know about paying for ABA services.
Colorado Insurance Mandates
Colorado law requires many insurance plans to cover the diagnosis and treatment of autism spectrum disorders, including ABA therapy. This applies to most state-regulated commercial plans.
Medicaid in Colorado
Colorado Medicaid (Health First Colorado) covers ABA therapy for eligible children. Key points:
- Coverage is available for children diagnosed with autism spectrum disorder
- A referral and prior authorization are typically required
- Some providers specialize in Medicaid billing and can help with the process
- Regional organizations like Colorado Access manage Medicaid in certain areas
- Authorization requirements: Most plans require prior authorization
- Session limits: Some plans have annual hour limits
- Provider networks: In-network providers will have lower out-of-pocket costs
- Deductibles and copays: These vary by plan
- Call your insurance company and ask specifically about ABA therapy coverage
- Get pre-authorization before starting services
- Ask providers about their insurance experience—some have dedicated billing staff
- Keep copies of all documentation and correspondence
- If denied, understand your appeal rights
Tricare Coverage
For military families in Colorado (near Fort Carson, Peterson, Buckley, etc.), Tricare covers ABA therapy. Tricare has specific requirements for provider credentialing and authorization.
Commercial Insurance
Most major commercial plans in Colorado cover ABA therapy, though specifics vary:
Tips for Families
Getting Help
Many Colorado ABA providers have insurance specialists who can help verify your benefits and navigate the authorization process. When comparing providers, consider asking about their insurance support services.
This article provides general information and should not be considered insurance or financial advice. Contact your insurance provider for specific coverage details.