What Pediatricians in Colorado Want You to Know About ABA Referrals

If your child was recently diagnosed with autism, your pediatrician probably handed you a stack of referrals and told you to call some phone numbers. Or maybe they just said, "You should look into ABA therapy" and left you to figure out the rest.

Either way, you are probably confused about what comes next. What does the referral process look like? Why does your doctor need to be involved? What can you do to speed things up?

I have talked to dozens of pediatricians across Colorado about how they handle autism diagnoses and ABA referrals. Here is what they want parents to understand.

Why Your Pediatrician Matters in the ABA Process

Most insurance companies in Colorado require a physician referral or prescription before they will authorize ABA therapy. This is not just bureaucracy. Insurance companies want documentation showing that a qualified medical professional has determined that ABA therapy is medically necessary for your child.

Your pediatrician serves as the gatekeeper for this process. Without their referral, you cannot get insurance to pay for services, and out of pocket ABA therapy costs hundreds of dollars per day.

Here is what your pediatrician typically needs to provide:

• A referral or prescription for ABA therapy. This is a document stating that your child has been diagnosed with autism spectrum disorder and that ABA therapy is recommended as a medically necessary treatment.
• A copy of or reference to the diagnostic evaluation. The evaluation report from whatever professional diagnosed your child (psychologist, developmental pediatrician, neurologist) supports the medical necessity claim.
• Sometimes a letter of medical necessity. Some insurance companies require an additional letter explaining why your specific child needs ABA therapy, including details about their functional limitations and how ABA will address them.

What Pediatricians Wish Parents Knew

After speaking with pediatricians across the Denver metro, Colorado Springs, and northern Colorado, a few themes come up consistently.

They want you to bring the diagnosis paperwork. If your child was evaluated by an outside specialist, your pediatrician may not have received the report yet. Medical records transfer slowly. Bring a copy of the evaluation to your next well child visit or schedule a follow up appointment specifically to discuss the diagnosis and next steps.

They want you to be specific about what you need. Instead of just asking, "What should I do?" come prepared with specific requests. "I need a referral for ABA therapy. My insurance is Anthem and they require a prescription from my primary care provider. Can you write that today?" This saves time and gets the process moving immediately.

They want you to know that they are not ABA experts. Pediatricians have broad training across all areas of child health. Most received minimal education about ABA therapy specifically during medical school and residency. They know it is evidence based and recommended for autism, but they may not be able to answer detailed questions about what therapy will look like or how many hours your child needs.

For those questions, they will refer you to a BCBA (Board Certified Behavior Analyst), who is the clinical specialist managing ABA treatment.

They want you to start the process before the official diagnosis. This is a big one. If your child is being evaluated for autism and you suspect the diagnosis is coming, start calling ABA providers now. Get on wait lists. Some providers will accept a pending diagnosis and start the intake process while you wait for the final evaluation report. Your pediatrician can sometimes write a referral based on clinical observations even before the formal evaluation is complete, especially if developmental concerns are well documented.

They want you to follow up. Pediatricians see 20 to 30 patients per day. They are not going to track whether your ABA referral went through. That is your job. If you submitted paperwork to your insurance two weeks ago and have not heard back, call them. If your referral was faxed to an ABA provider and they have not contacted you, call the provider directly. Be your child's advocate.

The Referral Process Step by Step

Here is how the ABA referral process typically works in Colorado:

Step 1: Get the autism diagnosis. This comes from a qualified professional, which in Colorado can be a licensed psychologist, developmental pediatrician, pediatric neurologist, or in some cases a licensed clinical social worker or professional counselor.

Step 2: Bring the diagnosis to your pediatrician. Schedule an appointment or send a message through the patient portal requesting a referral for ABA therapy. Attach or bring the evaluation report.

Step 3: Your pediatrician writes the referral. This is usually a one page document or a form in your child's medical record that states the diagnosis and recommends ABA therapy.

Step 4: You (or the ABA provider) submit the referral to insurance. Some ABA agencies handle this entirely. Others need you to submit the referral yourself or have your doctor's office send it directly to the insurance company.

Step 5: Insurance reviews and authorizes. The insurance company reviews the referral, the evaluation report, and sometimes an assessment from the ABA provider. They then authorize a specific number of ABA therapy hours per week for a defined period (usually six months to a year).

Step 6: Therapy begins. Once authorization is in place, the ABA provider schedules your child's sessions.

This whole process takes anywhere from a few weeks to a few months, depending on how quickly each step happens.

How to Speed Up the Process

There are things you can do to make this go faster.

• Get on the phone immediately after diagnosis. Do not wait a week to start calling. Call your pediatrician the same day to request the referral. Call ABA providers the same day to get on wait lists.
• Ask your doctor's office to prioritize the referral. Most offices handle referrals in the order they come in, but if you explain that ABA wait lists are months long and every day matters, some will expedite it.
• Provide everything the insurance company needs in one package. When you or your provider submits for authorization, include the referral, the full evaluation report, and any additional documentation the insurance company requires. Incomplete submissions get sent back, which delays everything.
• Follow up weekly. Call your insurance to check on authorization status. Call the ABA provider to ask about wait list position. Call your doctor's office to confirm the referral was sent. Be polite but persistent.
• Consider a provider who handles authorization for you. Many ABA agencies have dedicated intake coordinators who manage the entire insurance process on your behalf. This takes a huge burden off your shoulders.

When Insurance Denies Authorization

It happens. Insurance companies deny ABA authorization for all kinds of reasons: they say the documentation is insufficient, the diagnosis is not from an approved provider type, or the number of hours requested is too high.

If this happens, do not panic. Denials can be appealed, and many appeals are successful.

Your first step is to get the denial in writing. Read it carefully to understand the specific reason for the denial.

Then work with your pediatrician and your ABA provider to submit an appeal. This usually involves providing additional documentation that addresses the specific concern the insurance company raised.

If the appeal is denied, you can escalate to an external review. Colorado's Division of Insurance can help if you believe your insurance company is violating state law by denying coverage for medically necessary ABA therapy.

Your pediatrician can be a powerful ally in the appeal process. A letter from your child's doctor explaining why ABA therapy is medically necessary carries significant weight with insurance reviewers.

Special Considerations for Different Insurance Types

Employer sponsored plans (fully insured). These are subject to Colorado's autism insurance mandate, which requires coverage for ABA therapy. Your pediatrician's referral plus the evaluation report should be sufficient.

Self funded employer plans. These are governed by federal law (ERISA) rather than Colorado state law. Many still cover ABA, but they are not required to. Check your specific plan documents.

Medicaid (Health First Colorado). ABA is covered for children with autism. Your pediatrician needs to refer you, and the ABA provider needs to obtain prior authorization through the Medicaid system.

Tricare (military). ABA is covered, but the authorization process has additional steps. See your PCM for a referral and work with the Tricare regional contractor for authorization.

CHP+ (Child Health Plan Plus). This covers ABA therapy. The process is similar to Medicaid.

Building a Good Relationship with Your Pediatrician

Your pediatrician is going to be part of your child's care team for years. Here are some ways to build a productive relationship:

• Keep them informed. After ABA therapy starts, share progress updates. When your BCBA writes a report, send a copy to your pediatrician. This helps them understand what therapy involves and strengthens their ability to advocate for your child with insurance.
• Be respectful of their time. Appointments are short. Come prepared with a list of specific questions and requests. If you need a longer conversation, ask to schedule an extended appointment.
• Share what you are learning. Your pediatrician may not be an ABA expert, but they are eager to learn. If you attend a workshop or learn something useful about autism services in Colorado, share it. Many pediatricians appreciate parents who bring them information from the community.

If your current pediatrician is dismissive of your concerns about autism or resistant to providing referrals, find a new pediatrician. This is too important to be polite about. Your child needs a doctor who takes autism seriously and acts quickly.

The Pediatrician's Perspective

Most Colorado pediatricians I have spoken to are frustrated by the same things parents are frustrated by. They hate that wait lists are so long. They wish insurance authorization was simpler. They want more training in autism and ABA so they can better support their patients.

Many are actively working to improve the system. Some participate in the Colorado chapter of the American Academy of Pediatrics initiatives to improve autism screening and referral pathways. Others have developed relationships with specific ABA providers and can connect you directly.

Your pediatrician wants to help. They just need you to be their partner in the process. Come informed, come prepared, and come persistent. Together, you can navigate the system and get your child the services they need.