JBizNews Desk

June 2, 2026

A growing battle over autism-therapy billing is no longer just a concern for insurers and government healthcare programs. It is increasingly becoming a financial issue for the union health funds that cover millions of American workers and their families.

The warning comes as The Wall Street Journal reports that insurers are raising concerns about alleged fraud, excessive charges, and rapidly escalating costs within parts of the autism-treatment industry. In one case highlighted by the newspaper, a family received a surprise bill totaling $911,400 for autism-related services.

At the center of the controversy is Applied Behavior Analysis (ABA) therapy, one of the most widely used treatments for children diagnosed with autism spectrum disorder. The therapy is designed to help children develop communication, social, and everyday living skills. Demand has grown significantly across the United States over the past decade as autism diagnoses have increased.

While the need for treatment is broadly recognized, the cost of providing that care has become a growing concern among employers, insurers, government agencies, and benefit administrators.

The issue is particularly important for Taft-Hartley health funds, the jointly administered labor-management health plans established under the Labor Management Relations Act of 1947. These self-funded plans cover millions of union workers, retirees, and dependents in industries ranging from construction and transportation to manufacturing and public services.

Unlike traditional insurance companies, many Taft-Hartley plans directly pay healthcare claims using funds contributed by employers under collective bargaining agreements. When healthcare costs rise sharply, the financial burden ultimately falls on the fund and its participating members.

Under the federal Mental Health Parity and Addiction Equity Act, many self-funded plans are required to provide coverage for autism treatment in a manner comparable to other medical benefits. That means trustees often have limited flexibility when faced with large claims, particularly when services are delivered by out-of-network providers charging substantially higher rates.

Recent data suggest those pressures are accelerating.

According to benefits consultant Mercer, members generating annual autism-related claims exceeding $200,000 accounted for approximately 16% of total autism spending in 2024, up from 9% the previous year. Mercer found that many of the largest claims were associated with out-of-network providers.

In practical terms, a relatively small number of cases are consuming a growing share of healthcare dollars.

Large insurers have begun publicly acknowledging the challenge. Centene Corp., one of the nation’s largest healthcare companies, cited elevated autism-treatment costs as a contributor to higher-than-expected reimbursement expenses. Company executives described some of those costs as both “unanticipated” and “unacceptable.”

For union health plans operating with smaller reserves than national insurers, a handful of unusually large claims can have a disproportionate impact on finances.

Regulators have also intensified scrutiny of the industry.

Indiana has emerged as one of the most closely watched states after years of rapid growth in autism-treatment billing. According to public records reviewed by regulators, some providers billed rates as high as $640 per hour for services delivered by relatively junior staff members. One provider reportedly collected approximately $340,000 per patient in a single year.

State officials later revised reimbursement rules and moved to terminate certain provider billing privileges as part of a broader effort to curb excessive spending.

Meanwhile, federal investigators are examining billing practices nationwide. The Department of Health and Human Services Office of Inspector General found improper or potentially improper payments in every sampled Medicaid ABA claim reviewed across Colorado, Indiana, Maine, and Wisconsin, representing nearly $200 million in questioned spending.

The findings have intensified concerns that aggressive billing practices may not be confined to government healthcare programs.

Adding another layer to the issue is the growing role of private investment in the autism-treatment sector. Industry analysts estimate that private-equity firms have acquired more than 500 autism-treatment centers over the past decade, creating larger networks capable of rapidly expanding services and billing volume.

Supporters argue that investment has increased access to treatment for families seeking care. Critics counter that financial incentives can encourage excessive utilization and higher reimbursement demands.

For trustees overseeing union health funds, the challenge is becoming increasingly difficult.

Unlike publicly traded insurers, Taft-Hartley funds answer directly to workers and employers. Significant cost increases can translate into higher contributions, reduced reserves, increased participant costs, or difficult benefit decisions.

Healthcare experts say the growing debate over autism-treatment billing may ultimately extend far beyond Medicaid budgets and insurance-company earnings reports.

Federal investigators, state regulators, insurers, and benefits consultants are all examining the issue. The next question is whether the same cost pressures that have already affected government programs and large healthcare companies will increasingly land on self-funded union health plans.

If they do, the impact will be felt not on corporate balance sheets alone, but on the healthcare benefits that millions of working families rely upon every day.

Healthcare — JBizNews Desk

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