LAFAYETTE PARISH — As healthcare remains a hot topic nationwide, providers in Acadiana are voicing concerns about “increasing denials” of benefits for children with autism.
Executives at Aspire Behavioral Health Center and the Therapy Center of Acadiana say United Healthcare (UHC) is engaging in a targeted effort to restrict benefits for Applied Behavior Analysis (ABA) therapy, a state-mandated treatment for children with autism.
ABA therapy, which is available until children with autism turn 21, involves 20 to 40 hours per week of intensive work to help these children develop essential skills.
“We’re trying to minimize gaps in where the child with autism is as far as their developmental skills compared to their peers," said Dr. Joslyn McCoy, founder of Aspire Behavioral Health Center.
Dr. McCoy says there has been a 100% rate of partial denials for ABA claims over the past year. She fears that children who rely on this critical treatment could lose access if UHC continues its current practices.
"Members are being targeted because they’ve been in care for what the insurance companies consider too long, which goes against the law," Dr. McCoy said.
The Mental Health Parity Law prohibits health plans from imposing barriers to mental health care.
However, a recent report from ProPublica found that UHC’s parent company, UnitedHealth Group, through its subsidiary Optum, is preventing new providers from joining its network and terminating existing ones.
This could force families, like that of Sharelle Menard, to find new providers or pay out-of-pocket for costly ABA therapy.
Aspire has been audited and challenged by UHC and Optum regarding ABA claims.
“It’s been frustrating. We’ve done reversal interventions to prove that our clients need this therapy, but we either get no response or no decision on the appeal. It’s incredibly frustrating," said Whitney Newton, a behavior analyst at Aspire.
Jennifer Jordan, CEO of the Therapy Center of Acadiana, shares similar concerns about the growing trend of denials.
“The process is just arduous and ridiculous. It doesn’t make any sense, and it’s an obvious attempt to push us out,” Jordan said.
Richard Haik, an attorney at Morrow, Morrow, Bassett & Haik, who also has an autistic son, says he's also frustrated.
“What you’re seeing is insurance companies targeting the most vulnerable communities in order to save negligible amounts of money,” Haik said.
Optum Responds
An Optum spokesperson denied the allegations. The full statement reads:
“The ProPublica article grossly misrepresents our efforts to ensure the people we serve are getting the most effective, evidence-based care for their needs.”
The company added:
“Our programs are compliant with all applicable federal and state laws, align with widely accepted industry standards for clinical evidence, and result in expanded access to high-quality care. For example, we’ve expanded our ABA provider network by more than 110% over the past three years across all lines of business, with more than 46,000 ABA providers in our network nationwide.”
The future
For many families across Acadiana, there is growing concern about the future of ABA therapy and the impact of ongoing claim denials.
Sharelle Menard, whose son Benji is autistic, worries about the potential consequences.
“If the insurance companies can’t understand that these children need these services, and keep denying things that will help them grow, it’s not going to end well,” Menard said.
United Healthcare did not respond to our request for comment.
