UnitedHealthcare’s Secret Plan to Cut Autism Therapy Coverage
For years, Sharelle Menard feared her son Benji might never speak. His severe autism made communication difficult, leading to frustration and constant distress. But after two years of applied behavior analysis (ABA) therapy, he started forming words—his first being “bubbles.” The milestone brought hope that he might lead a more independent life.
That hope is now fading.
UnitedHealthcare, the nation’s largest insurer, is cutting coverage for ABA therapy, limiting access for children like Benji. Despite recommendations from his clinical team, the company has denied necessary treatment hours, leaving families scrambling for alternatives.
Internal documents reveal the motivation behind these decisions: a secret cost-cutting initiative designed to curb the growing expense of autism care. Optum, the UnitedHealth Group subsidiary managing mental health benefits, acknowledges ABA therapy as the “gold standard” for children with autism. However, the increasing number of diagnoses—now at 1 in 36 children—has driven up costs, leading the company to strategically reduce coverage.
UnitedHealthcare’s Strategy: Cutting Providers & Limiting Coverage
Internal reports from Optum outline a plan to restrict new providers from joining the network and eliminate existing ones, even in areas with long waitlists for ABA therapy. By dropping providers, United forces families to either search for new in-network clinicians or pay out-of-pocket, a cost that can reach tens of thousands of dollars per year.
Documents show that in some states, these cuts could impact:
- Over 40% of in-network ABA providers
- Up to 19% of patients currently receiving therapy
UnitedHealth primarily targets Medicaid beneficiaries, a population that includes some of the most vulnerable children. Since states pay private insurers a fixed sum per patient, companies profit by reducing services. This financial model incentivizes denials of medically necessary care, making it harder for families to access treatment.
Profit Over Patients: UnitedHealth’s Billions in Revenue
UnitedHealth Group, which made $22 billion in net profit last year, expects to spend $290 million on ABA therapy for Medicaid patients in 2024. With demand increasing, the company is heavily investing in strategies to reduce coverage, including:
- “Rigorous” clinical reviews to justify denials
- Authorizing fewer treatment hours than requested by doctors
- Delaying or rejecting claims to discourage continued therapy
These tactics have left parents like Menard feeling abandoned, as their children lose access to essential therapy. “We’ve worked so hard to get here,” she said. “Now they’re taking it away.”
The Future of Autism Coverage Under UnitedHealthcare
Experts warn that if UnitedHealth’s cost-cutting playbook becomes standard practice, other insurers may follow suit, jeopardizing coverage for thousands of children nationwide. As autism diagnoses continue to rise, the battle over insurance-provided therapy is likely to intensify.
For families affected, the fight isn’t just about coverage—it’s about their children’s future.
Source: CNN News