The following information is from Children’s Health Defense.
UnitedHealthcare, the nation’s largest insurer, has implemented a cost-cutting plan that restricts access to critical autism therapies. Internal documents reveal the company, through its Optum division, is limiting Applied Behavior Analysis (ABA), the gold standard for treating autism. Measures include terminating high-cost providers and denying coverage for medically necessary treatments, leaving families struggling to secure care for their children.
Ten-year-old Benji Menard is one of the children affected. Diagnosed with severe autism at age three, Benji initially made progress with intensive therapy, developing basic communication skills and reducing his frustration. However, UnitedHealthcare began denying requests for the therapy hours his clinicians say he urgently needs. His mother, Sharelle Menard, described the devastating effects: “This motivation and momentum—when you lose that, it’s so hard to get it back.”
Benji’s hard-earned progress is now at risk. Without the necessary hours of care, his behavior has started to regress, with increased tantrums and difficulties adjusting to daily routines. His therapists warn that losing access to therapy could undo much of the strides he’s made, jeopardizing his chances of achieving greater independence.
“We know what he needs. It’s in our scope of practice, and it’s our right as the provider to determine that. They’re cutting and denying an unethical amount.”
—Whitney Newton, Behavior Analyst
Internal company documents show UnitedHealthcare’s plan could exclude up to 40% of ABA therapy providers in states like Louisiana, potentially impacting one in five children. Families relying on Medicaid or private insurance are often forced to pay out-of-pocket or give up treatment. Advocates have expressed outrage over the company’s approach.
“They’re denying access to treatment and shrinking a network at a time when they clearly know that there is an urgent need.”
—Karen Fessel, Mental Health and Autism Insurance Project
Experts warn the restrictions could violate Medicaid laws requiring adequate provider networks and increase long-term costs as untreated children may need more intensive services later in life.
“Yes, this therapy can be expensive. But solving the problem by denying kids access to medically necessary care is a terrible solution.”
—Dan Unumb, President, Autism Legal Resource Center
Families like the Menards are left to fight for their children’s progress. As Sharelle Menard explained, therapy is not about changing who her son is but ensuring he can lead a safer, more independent life: “There’s nothing else that I’ve known to work.”
Read the full article here.
I know that trying to limit care for autistic people by UH is just another example of their disregard for patients suffering However, ABA is a somewhat controversial therapy that has been described as punishment centered for natural stimming behaviors causing a lot of frustration and meltdowns for some children that struggle to control those behaviors. The book, “Underestimated, An Autism Miracle.” documents how ABA therapists try to undermine therapies like S2C that have had incredible breakthroughs for nonverbal children and teens. I highly recommend it.
If we all lived a healthy lifestyle, ate real food and excercised often healthcare would be inexpensive. The healthy people are subsidizing the people who don’t care about their health and follow unhealthy lifestyles. Preexisting conditions could easily be covered if the sickos would not create those preventable conditions by being lazy and not living healthy lives. Health, in most cases, is a choice. So why do we have to pay for dumb people’s dumb lifestyle choices?
I think the autism tsunami we are experiencing will have deep and far-ranging effects for the entire country. The costs associated with it are astronomical.