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tenderfoot

(8,982 posts)
Fri Dec 13, 2024, 09:35 AM Dec 13

UnitedHealth Is Strategically Limiting Access to Critical Treatment for Kids With Autism

Reporting Highlights

Secret Playbook: Leaked documents show that UnitedHealth is aggressively targeting the treatment of thousands of children with autism across the country in an effort to cut costs.

Critical Therapy: Applied behavior analysis has been shown to help kids with autism; many are covered by Medicaid, federal insurance for poor and vulnerable patients.

Legal Questions: Advocates told ProPublica the insurer’s strategy may be violating federal law.


ProPublica has obtained what is effectively the company’s strategic playbook, developed by Optum, the division that manages mental health benefits for United. In internal reports, the company acknowledges that the therapy, called applied behavior analysis, is the “evidence-based gold standard treatment for those with medically necessary needs.” But the company’s costs have climbed as the number of children diagnosed with autism has ballooned; experts say greater awareness and improved screening have contributed to a fourfold increase in the past two decades — from 1 in 150 to 1 in 36.

So Optum is “pursuing market-specific action plans” to limit children’s access to the treatment, the reports said.

“Key opportunities” are outlined in bullets in the documents. While acknowledging some areas have “very long waitlists” for the therapy, the company said it aims to “prevent new providers from joining the network” and “terminate” existing ones, including “cost outliers.” If an insurer drops a provider from its network, patients may have to find a new clinician that accepts their insurance or pay up to tens of thousands of dollars a year out of pocket for the therapy. The company has calculated that, in some states, this reduction could impact more than two-fifths of its ABA therapy provider groups in network and up to 19% of its patients in therapy.

https://www.propublica.org/article/unitedhealthcare-insurance-autism-denials-applied-behavior-analysis-medicaid
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Johnny2X2X

(22,168 posts)
4. I hope this becomes a series of stories
Fri Dec 13, 2024, 10:22 AM
Dec 13

Last edited Fri Dec 13, 2024, 12:59 PM - Edit history (1)

The murder of this exec was wrong and no one is celebrating it, but let's hope this brings attention to the immoral and frankly evil practices of these health care giants.

erronis

(17,647 posts)
6. ProPublica has a good track record of sticking to a story for a long time and deep digs.
Fri Dec 13, 2024, 11:39 AM
Dec 13

They had a conference call yesterday (may be recorded) that talked about some of the stories that started out fairly small and then expanded in depth and scope.

They also mentioned that once they start reporting on a story some of the other (bigger?) outlets start caring and carrying it.

GB_RN

(3,296 posts)
8. From What I've Read Elsewhere...
Fri Dec 13, 2024, 12:15 PM
Dec 13

There are some social media-based, “Internet sleuths” who usually jump in to help LE identify and find guys like Luigi (can’t say that without thinking of Mario Brothers, or with a straight face). Not ONE of them jumped on this case. Shows how despised people like the now-deceased CEO are.

lark

(24,482 posts)
7. Pure evil incarnate!
Fri Dec 13, 2024, 11:41 AM
Dec 13

And big business is so butt hurt that Americans are applauding killing a person who killed countless numbers of it's American clients.
Geeze how clueless can they get?

I don't condone killing the murderous CEO in retaliation, killing is wrong! However in karmic terms, he certainly earned it.

GB_RN

(3,296 posts)
9. To Paraphrase H.L. Mencken...
Fri Dec 13, 2024, 12:17 PM
Dec 13

No one ever lost money by underestimating the intelligence of the American public.

That obviously applies across social strata.

azureblue

(2,347 posts)
10. the CEO
Fri Dec 13, 2024, 12:19 PM
Dec 13

Killed people with business decisions. Not a gun, so which is worse? The person who kills one person or the person who kills thousands, but by business decision?

lark

(24,482 posts)
12. The CEO and the company execs are far worse.
Fri Dec 13, 2024, 12:52 PM
Dec 13

I'm pushisng my friend to change companies, UHC is not her friend.

IbogaProject

(4,014 posts)
13. Time for single payer 100% coverage
Fri Dec 13, 2024, 01:32 PM
Dec 13

100 % beyond small copays and maybe a modest deductable. We are all healthier w every one covered all the time. Big pharma and medicsl treatment corps dont want all the health outcomes in a single researchable database. Every other peer country is healthier with lower expenses.

Ruby the Liberal

(26,357 posts)
14. Its still early, and I am not an apologist for what he did
Fri Dec 13, 2024, 08:44 PM
Dec 13

but Mr Luigi Mangione may have unleashed awareness in a way that could actually change things.

The fact that this issue is still forefront in the news cycle is really amazing. And welcome.

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