UnitedHealth Is Strategically Limiting Access to Critical Treatment for Kids With Autism [View all]
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 insurers strategy may be violating federal law.
ProPublica has obtained what is effectively the companys 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 companys 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 childrens 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