Young Benji, who has made great strides, is among the youngsters whose access to necessary autism therapy is being restricted by UnitedHealth’s internal cost-cutting policy.
Experts caution that the company’s activities may have long-term effects on state healthcare systems and children’s development as the number of insurance denials rises.
It seemed miraculous to Sharelle Menard to watch her son Benji say his first words following rigorous autism treatment. However, Benji’s future is now in doubt as his insurer, UnitedHealthcare, starts to refuse the treatment that has been essential to his development.
Thousands of autistic children nationwide may be impacted by this decision, which was made as part of a covert cost-cutting initiative.
At the age of three, Benji, who is now ten, received a severe autism diagnosis. He underwent years of rigorous Applied Behavior Analysis (ABA) therapy, an evidence-based approach that has been shown to assist autistic youngsters in acquiring critical abilities.
Benji’s therapists have insisted that he requires more care to prevent regression, but UnitedHealthcare’s subsidiary, Optum, has begun refusing him more therapy hours due to cost concerns.
Examining claims for medical necessity and shrinking provider networks are two tactics Optum is using to restrict access to ABA therapy, according to internal papers.
Even as the number of children with autism diagnoses rises, the business, which manages Medicaid insurance in multiple states, has targeted autism therapies because of their growing costs.
Experts are concerned about the possible repercussions. Autism advocate Karen Fessel stated that it is “unconscionable” to deny someone access to treatment.
Experts caution that depriving children of essential therapy could ultimately cost the system more money in addition to endangering their development.
Menard worries about how it will affect Benji’s hard-earned advancement. She acknowledged that her son might find it difficult to succeed in the future without the right assistance, saying, “Losing momentum is so hard to recover.”
