United Health Care just cannot get it right. No matter, they don't care.
The diagnosis of autism (a neurodivergent diagnosis) has been made more often during the last decade. Many physicians and research programs are investigating the epidemiology of the diagnosis.
Secret Playbook: Leaked documents show that UnitedHealth is aggressively targeting the treatment of thousands of children with autism across the country to cut costs. 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.
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.
United administers Medicaid plans or benefits in about two dozen states and for more than 6 million people, including nearly 10,000 children with autism spectrum disorder. Optum expects to spend about $290 million for ABA therapy within its Medicaid plans this year, and it anticipates the need to increase, documents show. The number of Medicaid patients accessing specialized therapy has increased by about 20% over the past year, with expenses rising by about $75 million year-on-year.
UHC proactively analyzed the increased requests for advanced behavioral therapy calculating it would deny authorizations for treatment based solely upon the diagnosis. This diagnosis would exclude treatment for this disorder even if the benefits included behavioral therapy.
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