When Carolina Lopez was looking for treatment for her three-year-old autistic son, she thought she had found the solution. A company promised him immediate treatment without any financial burden.
A few months later, he was faced with a bill that exceeded $911,000. Her case, the Wall Street Journal reports, exposes a dark side of the autism treatment industry, where accusations of overpricing, bogus services and questionable practices are on the rise.
The market that was launched with the diagnostics
Autism treatment, and especially applied behavior analysis, was until a few years ago a relatively minor specialty in pediatric care.
However, the increase in diagnoses, the expansion of insurance coverage and the entry of new providers have turned the US industry into a multi-billion dollar market.
According to data cited by the Wall Street Journal, spending on autism treatments is now among the fastest-growing healthcare categories in the United States.
For about 40 large employers covering 3.5 million policyholders, annual spending on autism treatments doubled between 2021 and 2025, reaching $108 million.
Insurance companies are experiencing an explosion in the number of suspicious claims
The rapid growth of the market is accompanied by more complaints about abusive practices.
Insurer Aetna says the number of cases where autism treatment providers found evidence of fraud or improper billing rose 300 percent between 2024 and 2025 and is expected to rise even more this year.
Among the problems identified are incomplete documentation, double billing for the same hours of treatment, and even statements of services being provided to addresses that do not exist.
Some providers charge amounts that shock even seasoned insurance company auditors. The fee for a single child exceeded $30,000 per day, notes the WSJ, cited by Naftemporiki.
70 minute treatment, $30,500 fee
The case of little Ezekiel Lopez is typical.
According to data cited by the Wall Street Journal, on August 18, a behavioral technician worked with the child for a total of 70 minutes, using puzzles and educational games.
For that day, the company submitted a claim for $15,200 for the technician and another $15,300 for his supervisor. In total, the bill came to $30,500, or about $436 per minute of treatment.
The insurance company eventually paid about $15,000 to settle that claim.
The child's mother also claims that there were days when services were charged without anyone showing up for treatment.
From insurance companies to families
The problem doesn't stop with insurance companies. When insurers refuse to pay fees they deem excessive or unjustified, some providers go directly to families.
In Lopez's case, when the insurance company stopped paying for the services, it sent him a bill for $911,400, which was later increased to $916,000.
She says she was not adequately informed that it was an out-of-network provider and describes the experience as deeply traumatic.
“I know there are parents like me who need help and are desperate. You're trying to do the best for your child, and some people take advantage of that,” he told the Wall Street Journal.
Minimal supervision, huge profits
The business model is also favored by the relatively lax US regulatory framework.
In many US states, starting an autism therapy business requires far fewer inspections than a daycare.
At the same time, most treatments are provided by behavioral technicians who, in many cases, only have a high school diploma and are paid about $20 an hour.
Despite this, fees to insurance companies and employers can reach extremely high levels.
The Wall Street Journal notes that the number of registered behavioral technicians in the US will grow 457% between 2019 and 2025, reaching 535,000.
The authorities are starting to react
The explosive growth in spending and allegations of abuse have already caused backlash.
The state of Indiana plans to temporarily freeze enrollment of new autism treatment providers in the Medicaid program while insurance companies step up checks.
At the same time, large companies and insurance organizations went to court, complaining of overestimated prices by millions of dollars.
The question now is not just how to ensure access to necessary treatments for children with autism. But how to prevent the transformation of an essential medical service into a field of speculation at the expense of families who often have no other option.
