UMR ABA therapy coverage, handled from your first call
Achieve ABA Therapy Group works directly with UMR to verify your benefits, confirm what your plan covers, and manage every authorization along the way — so navigating your ABA therapy coverage never falls on you.
- UMR accepted
- We handle verification & authorizations
- BCBA-led care teams
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How UMR ABA therapy coverage works in Colorado
If you’re asking whether UMR covers ABA therapy, the honest answer is that it depends on your specific plan more than it does with some other insurers. UMR is a third-party administrator owned by UnitedHealthcare, and it’s most often used to administer self-funded employer health plans. That distinction matters in Colorado, because the state’s autism insurance mandate applies to fully-insured plans regulated by the Colorado Division of Insurance. Self-funded plans, even when UMR handles the paperwork, fall under federal ERISA rules instead, so coverage for ABA therapy depends on what your specific employer chose to include.
The good news is that many employers do include ABA therapy in their UMR-administered plans. The only way to know for sure is to check your specific benefits, which is exactly what we do before anything else.
At Achieve, here’s what that looks like in practice: we verify your specific UMR plan and benefits before you commit to anything, we submit and follow up on every authorization ourselves, we walk you through your actual costs upfront, and when claims or appeals get complicated, we’re the ones dealing with UMR, not you.
We check everything first
Tell us about your UMR plan, and we'll find out exactly what's covered, including whether ABA therapy is part of your specific employer's plan, before you commit to anything.
We handle authorization
UMR recommends a medical necessity review for ABA therapy even when formal prior authorization isn't required. We submit the paperwork, follow up with UMR, and respond to any requests for more information.
We explain your real costs
Before your child's first session, you'll know what UMR covers and what you're responsible for. Clear numbers, explained plainly.
We manage the paperwork
Claims, follow-up calls, resubmissions, and appeals when coverage gets denied. We handle it so you don't have to.
We’re not working on abstract goals but on the things you need to change.
Why UMR coverage varies by plan
Most UMR plans are self-funded, meaning your employer pays claims directly and hires UMR to administer the paperwork. Because these plans aren’t automatically bound by Colorado’s state autism mandate, whether ABA therapy is covered comes down to what your employer built into the plan design. This is different from a fully-insured plan, where state law requires coverage regardless of what the employer wants. We always check this first, since assuming either way could lead to a surprise later.
- Boulder County
- Broomfield County
- Clear Creek County
- El Paso County
- Gilpin County
- Jefferson County
- Park County
- Teller County
If your family lives in Boulder, Colorado Springs, Lakewood, or a nearby community within these counties, there’s a good chance CCHA is already your regional organization. If you’re not sure, we can help you find out.
What ABA therapy benefits include when covered by UMR
When UMR approves ABA therapy, coverage typically includes:
In-home ABA therapy
One-on-one sessions in your home, where your child works on communication, behavior, social skills, and daily living skills with a trained therapist.
School support
Coordination with your child's school so the skills they're building carry into the classroom and through the rest of their day.
Progress monitoring
Regular reviews and plan adjustments from your BCBA, to make sure therapy keeps moving toward your child's goals.
Coverage specifics vary significantly by employer plan. We’ll walk you through exactly what yours includes once your benefits are verified.
Some children also qualify for Medicaid waivers, which add services like respite care or home modifications on top of standard coverage
UMR ABA therapy across Colorado
The UMR approval process for ABA therapy
Before Anthem can approve ABA therapy, your child needs a formal autism spectrum disorder diagnosis from a qualified provider. If you don’t have one yet, we can help point you toward next steps.
Reach out
Call us or fill out our contact form. We’ll ask for your UMR information and your child’s diagnosis paperwork.
We verify everything
We confirm whether your specific UMR plan includes ABA therapy and what’s covered. No surprises.
We handle the review process
UMR recommends a pre-determination medical necessity review for ABA therapy, even in cases where formal prior authorization isn’t strictly required. We submit this along with the required clinical documentation and follow up until it’s resolved.
Therapy begins
Once approved, we schedule your child’s first session, in your home, on a schedule that works for your family.
FAQs about UMR and ABA therapy in Colorado
Does UMR cover ABA therapy?
It depends on your specific plan. Many UMR-administered employer plans include ABA therapy, but since most are self-funded, coverage isn’t guaranteed the way it is with fully-insured plans. We verify this for you before anything begins.
Some children may also qualify for a Medicaid waiver, which adds extra support like respite care or home modifications on top of standard coverage. See our guide to Colorado Medicaid waivers explained.
Why doesn't Colorado's autism mandate automatically apply to my UMR plan?
Colorado’s mandate applies to fully-insured plans regulated by the state. Most UMR plans are self-funded employer plans, which fall under federal ERISA rules instead. Coverage depends on what your employer chose to include.
How do I find out if my UMR plan covers ABA therapy?
The fastest way is to let us verify your benefits directly. You can also check your plan documents or ask your employer’s HR or benefits department.
Does UMR require prior authorization for ABA therapy?
Requirements vary by plan. UMR recommends a medical necessity review even when formal prior authorization isn’t required, and we handle this process either way.
What if my UMR plan doesn't cover ABA therapy?
We’ll talk through other options, including whether a family member has a different plan that might apply, self-pay rates, or payment plan options.
Let's get you covered
Our team at Achieve ABA Therapy Group has worked through UMR plans across Colorado and understands how much coverage depends on individual employer plan design. We’ve helped families across Denver, Aurora, Colorado Springs, and beyond figure out their coverage. Let us help yours too.