“UnitedHealth’s Secret Playbook: The Fight for Autism Therapy Coverage”
ProPublica has uncovered a disturbing revelation about UnitedHealthcare’s internal cost-cutting campaign that targets the treatment of thousands of children with autism across the country. Leaked documents obtained by ProPublica reveal that the insurer, UnitedHealthcare, is aggressively denying necessary therapy hours to children with autism, including Benji, a young boy in Louisiana.
Benji’s mother, Sharelle Menard, has seen the transformative effects of specialized therapy on her son. After years of therapy, Benji went from being non-verbal to speaking small words like “bubbles.” However, UnitedHealthcare has now started denying the hours of therapy that Benji requires to maintain his progress. This denial is part of a secret internal cost-cutting campaign by UnitedHealthcare to reduce the financial burden of treating children with autism.
The leaked documents show that UnitedHealthcare’s division, Optum, is actively pursuing strategies to limit children’s access to applied behavior analysis (ABA) therapy, the gold standard treatment for autism. Optum is targeting ABA providers for scrutiny based on billing patterns and is using rigorous utilization management to deny covered treatment.
Experts and advocates have expressed outrage over UnitedHealthcare’s strategy, calling it unethical and potentially illegal. The federal mental health parity law requires insurers to provide equal access to mental health and physical care, raising questions about UnitedHealthcare’s actions.
Despite the denials, Benji continues to receive the necessary therapy, but the battle with the insurer is ongoing. The therapy center where Benji receives treatment is facing challenges due to Optum’s refusal to pay for the required hours of care. The center’s founder, Joslyn McCoy, is determined to fight for her patients’ rights and ensure they receive the care they need.
The implications of UnitedHealthcare’s cost-cutting campaign are far-reaching, potentially harming children with autism and driving clinics out of business. The need for ABA therapy is not going away, and the battle for access to care continues for families like Benji’s.
As the investigation unfolds, ProPublica is seeking insights from mental health providers, health insurance insiders, and patients to further examine the U.S. mental health care system. The impact of UnitedHealthcare’s actions on children with autism underscores the importance of ensuring access to necessary treatments for all individuals in need.