ABA therapy insurance coverage in NC, MD, AK, NM, CO, UT and SD

Verified.Authorized.Covered.

Insurance should never stand between your child and the therapy they need. At Epic Minds, we handle the whole process, from your first benefits call through every reauthorization, so it isn't.

  • We check your coverage first
  • We get the approval for you
  • You know your costs up front

Check your coverage

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How ABA insurance coverage works

We handle the insurance, so you don’t have to

By the time you’re looking for ABA therapy, you’ve already been through evaluations, waiting lists and a lot of worry. Figuring out insurance shouldn’t be one more job on your list.

  1. 1

    We check your coverage first

    Tell us about your plan, and we’ll confirm what’s covered before you commit to anything.

  2. 2

    We get the authorization

    Most plans require approval before ABA therapy begins. We submit the paperwork, follow up and answer any requests for more information.

  3. 3

    We explain your costs

    Before your child’s first session, you’ll know what your plan covers and what, if anything, you’ll pay.

  4. 4

    We keep coverage on track

    We track your authorization and request renewals before it runs out, so your child’s therapy doesn’t pause.

Get started

Insurance plans we accept by state

Find your plan, and breathe easier

We accept Medicaid and all major insurance plans in the states we serve. Don’t see your plan? Call us anyway, because there’s a good chance we can work with it.

North Carolina

Private insurance

Marketplace plans

  • Ambetter of North Carolina
  • AmeriHealth Caritas Next
  • Oscar Health Plan of North Carolina
  • UnitedHealthcare
  • Blue Cross NC plans (Blue Value, Blue Advantage, Blue Local and Blue Home with Novant Health)

Employer and self-funded plans

  • UMR
  • Meritain Health
  • Allied Benefit Systems
  • Luminare Health
  • ACS Benefit Services
  • Healthgram
  • MedCost Benefit Services
  • Key Benefit Administrators
  • Lucent Health
  • Imagine360
  • Crescent Health Solutions
  • CWI Benefits

Public employee plans

  • North Carolina State Health Plan (Standard PPO, Plus PPO and HDHP)
  • Duke University employee plans

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Foreign Service Benefit Plan
  • Aetna and UnitedHealthcare FEHB options

Maryland

Maryland Medicaid (HealthChoice)

HealthChoice plans

  • Aetna Better Health of Maryland
  • CareFirst BlueCross BlueShield Community Health Plan Maryland
  • Jai Medical Systems
  • Kaiser Permanente
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare Community Plan
  • Wellpoint Maryland

ABA services managed through Carelon Behavioral Health

Maryland Medicaid fee-for-service, for families outside HealthChoice

The Maryland Children’s Health Program (MCHP and MCHP Premium), which runs through the same plans

Private insurance
  • CareFirst BlueCross BlueShield
  • Aetna
  • Cigna
  • UnitedHealthcare
  • Kaiser Permanente

Marketplace plans

  • CareFirst (BlueChoice, GHMSI and CFMI)
  • Kaiser Permanente
  • UnitedHealthcare, whose Maryland marketplace plans are issued as Optimum Choice
  • Wellpoint Maryland

Other commercial plans

  • UnitedHealthcare of the Mid-Atlantic
  • MAMSI
  • M.D. IPA
  • Anthem Blue Cross Blue Shield out-of-state plans

Employer and self-funded plans

  • UMR
  • CareFirst Administrators
  • Meritain Health
  • Luminare Health
  • Allied Benefit Systems
  • HealthSmart Benefit Solutions
  • Trustmark

Public employee plans

  • Maryland State Employee and Retiree Health Benefits Program (CareFirst PPO and EPO, UnitedHealthcare Choice Plus and Choice EPO and Kaiser Permanente IHM)
  • Baltimore County and Montgomery County employee plans
  • Johns Hopkins plans (Johns Hopkins EHP and the Johns Hopkins University Enhanced PPO and HDHP)

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • MHBP
  • NALC Health Benefit Plan
  • APWU Health Plan
  • Compass Rose
  • SAMBA
  • Aetna, CareFirst BlueChoice, Kaiser Permanente Mid-Atlantic and UnitedHealthcare FEHB options

Alaska

Alaska Medicaid

Alaska Medicaid is fee-for-service, so there are no managed care plans to choose between. Denali KidCare carries the same Medicaid benefits, and children enrolled through it get their own Denali KidCare card, so bring that one to appointments

Private insurance
  • Premera Blue Cross Blue Shield of Alaska
  • Aetna
  • Moda Health
  • UnitedHealthcare

Marketplace plans

  • Premera Blue Cross Blue Shield of Alaska statewide
  • Moda Health in Anchorage, Mat-Su, Kenai, Fairbanks North Star and Southeast

Employer and self-funded plans

  • Cigna
  • UMR
  • Plans administered by Aetna

Public employee plans

  • AlaskaCare employee and retiree plans
  • Municipality of Anchorage employee plan

Union and trust plans

  • Alaska Electrical Trust Funds
  • Alaska Teamster-Employer Welfare Trust
  • IAFF Health & Trust
  • UA Local 367 Trust
  • Public Education Health Trust
  • GGU, LTC and PSEA health trusts

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Aetna FEHB options

New Mexico

New Mexico Medicaid (Turquoise Care)

Turquoise Care plans

  • Blue Cross and Blue Shield of New Mexico
  • Molina Healthcare of New Mexico
  • Presbyterian Health Plan
  • UnitedHealthcare Community Plan

New Mexico Medicaid fee-for-service, including Native American families who opt out of managed care

CHIP, which runs through the same Turquoise Care plans

Private insurance
  • Blue Cross and Blue Shield of New Mexico
  • Presbyterian Health Plan
  • Aetna
  • Cigna
  • UnitedHealthcare

Other commercial plans

  • Presbyterian Insurance Company, which is Presbyterian’s PPO plan

Employer and self-funded plans

  • UMR
  • Meritain Health
  • HealthSmart
  • HealthSCOPE Benefits
  • Allied Benefit Systems

Public employee plans

  • State of New Mexico employee benefits
  • NMPSIA
  • Albuquerque Public Schools
  • New Mexico Retiree Health Care Authority
  • UNM LoboHealth
  • UNM Student Health Plan

Large employer plans

  • Sandia Total Health
  • Los Alamos National Laboratory PPO and HDHP
  • TXNM Energy plan, which your paperwork may still call PNM

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Presbyterian and Aetna FEHB options

Veterans’ families

  • CHAMPVA, which covers ABA therapy with pre-authorization

Colorado

Colorado Medicaid

Medicaid managed care

  • Rocky Mountain Health Plans PRIME
  • Elevate (Denver Health Medicaid Choice)

Regional Accountable Entities

  • Rocky Mountain Health Plans
  • Northeast Health Partners
  • Colorado Community Health Alliance
  • Colorado Access
Private insurance
  • Anthem Blue Cross and Blue Shield
  • Kaiser Permanente
  • Rocky Mountain Health Plans
  • Denver Health Medical Plan
  • Aetna
  • Cigna
  • UnitedHealthcare

Marketplace plans

  • Select Health
  • Colorado Option plans sold by Anthem, Cigna, Denver Health, Kaiser Permanente, Rocky Mountain Health Plans and Select Health

Employer and self-funded plans

  • UMR
  • Meritain Health
  • Luminare Health
  • Allegiance Benefit Plan Management
  • UCHealth Plan Administrators
  • Colorado Employer Benefit Trust

Public employee plans

  • State of Colorado employee plan
  • CU Health Plan
  • Denver Public Schools plan

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Foreign Service Benefit Plan
  • Aetna, Kaiser Permanente and UnitedHealthcare FEHB options

Utah

Utah Medicaid
  • Utah Medicaid
  • Healthy U
  • Molina Healthcare of Utah
  • SelectHealth Community Care

Also Health Choice Utah, the HOME Program and Utah CHIP through Healthy U, SelectHealth and Molina

Private insurance
  • SelectHealth
  • Regence BlueCross BlueShield of Utah
  • U of U Health Plans
  • PEHP
  • DMBA
  • Aetna
  • Cigna
  • UnitedHealthcare

Marketplace plans

  • Healthy Premier (a U of U Health Plans product)
  • BridgeSpan Health
  • Imperial Health Plan of the Southwest
  • SelectHealth

Other commercial plans

  • Angle Health
  • WMI Mutual
  • EMI Health
  • MotivHealth

Employer and self-funded plans

  • UMR
  • Meritain Health
  • Tall Tree Administrators
  • U of U Health Plans

Public employee and large employer plans

  • University of Utah employee plans
  • Utah State University plan
  • BYU plans administered by DMBA

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Aetna and SelectHealth FEHB options

Veterans’ families

  • CHAMPVA, which covers ABA therapy with pre-authorization

South Dakota

South Dakota Medicaid

South Dakota Medicaid and CHIP cover ABA therapy for eligible children, subject to medical necessity and prior authorization. South Dakota uses fee-for-service with primary care case management through PRIME, so there are no managed care plans to choose between

Private insurance
  • Wellmark Blue Cross and Blue Shield of South Dakota
  • Sanford Health Plan
  • Avera Health Plans
  • Aetna
  • Cigna
  • UnitedHealthcare

Marketplace plans

  • Avera Health Plans
  • Sanford Health Plan
  • Wellmark Blue Cross and Blue Shield of South Dakota (Wellmark in select counties)

Other commercial plans

  • HealthPartners
  • Medica

Employer and self-funded plans

  • DAKOTACARE
  • UMR
  • Meritain Health
  • Allied Benefit Systems
  • Luminare Health

Public employee plans

  • South Dakota State Employee Health Plan
  • South Dakota School District Benefits Fund

Federal employee plans

  • Blue Cross and Blue Shield Service Benefit Plan (FEP Blue Standard, Basic and Focus)
  • GEHA
  • APWU Health Plan
  • MHBP
  • SAMBA
  • Compass Rose
  • Aetna FEHB options

Veterans’ families

  • CHAMPVA, which covers ABA therapy with pre-authorization

Check my coverage

A therapist working one-on-one with a child at a table at home

What ABA insurance benefits usually cover

Your plan likely covers more than you think

When your plan approves ABA therapy, coverage often includes:

  • In-home ABA therapy

    One-on-one sessions at home, working on communication, social skills, daily living skills and behavior.

  • Parent training

    Strategies you can use every day to keep progress going between sessions.

  • Assessments and progress monitoring

    Regular check-ins and plan updates from your child’s BCBA.

Coverage varies by plan, and we’ll walk you through exactly what yours includes.

The ABA insurance approval process

Getting approved is simpler than it sounds

  1. 1

    Step 1: Reach out

    Call us or fill out the form. We’ll ask for your insurance information and your child’s diagnosis paperwork.

  2. 2

    Step 2: We verify your benefits

    We contact your insurance company and let you know what’s covered.

  3. 3

    Step 3: We handle authorization

    We submit the request with the required documents and follow up until it’s approved.

  4. 4

    Step 4: Therapy begins

    Once approved, we schedule your child’s first session.

Start today

Getting the most from your ABA benefits

A few small steps for a smooth start

A parent carrying a child on their shoulders while walking through a sunny field

Before you start

  • Have your insurance card ready (front and back)
  • Gather your child’s autism diagnosis paperwork, if you have it
  • Ask us about anything else your plan might need

During therapy

  • We track your benefits and authorization dates
  • We submit renewals before your current authorization ends
  • We keep you updated on your coverage

ABA therapy insurance FAQs

Answers to put your mind at ease

Which insurance plans do you accept?

We accept Medicaid and all major insurance plans in North Carolina, Maryland, Alaska, New Mexico, Colorado, Utah and South Dakota. The only exception is TRICARE.

Do you accept TRICARE?

Not at this time.

Does Medicaid cover ABA therapy?

Yes. Medicaid covers ABA therapy for eligible children in every state we serve. We’ll check your child’s plan for free.

Will insurance pay for all of it?

It depends on your plan. Many Medicaid families pay little or nothing. Private plans may have copays, deductibles or coinsurance. We’ll tell you exactly what to expect before therapy starts.

Do we need a diagnosis first?

Most plans require an autism diagnosis before covering ABA therapy. Still waiting on one? Ask us about our autism diagnosis services.

Do I need a referral from my pediatrician?

Some plans require one and some don’t. We’ll tell you what your plan needs and help you get the paperwork.

What if my insurance says no?

We’ll work with you and your child’s care team on next steps, including gathering more documentation when it’s needed.

What happens when my authorization runs out?

We track your authorization dates and request renewals ahead of time, so there’s no gap in your child’s therapy.

Can I use my HSA or FSA?

ABA therapy is generally an eligible medical expense, so you can usually use HSA or FSA funds for out-of-pocket costs. Check with your plan to confirm.

My plan isn’t listed. Can you still help?

Yes. Call us at 855-995-3742, and we’ll check your coverage for free.

Check your ABA insurance coverage today

Let’s take this off your plate

It’s free, it’s quick, and we’ll walk you through every step.

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