ABA Centers of America Sues Point32Health for $80 Million Over Autism Therapy Insurance Dispute

ABA Centers of America, one of the nation’s fastest-growing autism therapy providers, has filed an $80 million lawsuit against Point32Health, alleging that the insurer has systematically failed to pay for authorized services. The lawsuit claims that Point32Health and its subsidiary, Harvard Pilgrim Health Care, have placed claims in an indefinite “pend status,” preventing reimbursement without issuing formal denials. Since December 2023, ABA Centers of America alleges it has not received any payments for autism therapy services, despite prior authorization.

This autism therapy insurance dispute highlights a growing concern within the healthcare industry—so-called “payer ghosting,” where insurers delay claims indefinitely, leaving providers in financial limbo. According to the lawsuit, Point32Health has not disputed the necessity of these services, yet continues to obstruct payments, creating significant barriers to care.

The Fight for Autism Therapy Coverage

Christopher Barnett, founder and chairman of ABA Centers of America, has voiced frustration over the insurer’s alleged actions. He states that his team has made multiple attempts to work with Point32Health to ensure access to autism therapy for its members, but the insurer has not responded adequately.

“We believe this lawsuit is necessary to attempt to halt the irresponsible and unreasonable behavior by Point32,” Barnett said. “We have tried for months and months to partner with Point32 in order to provide adequate care to their subscribers.”

Despite the ongoing autism therapy insurance dispute, ABA Centers of America continues to treat children covered by Point32Health, refusing to discharge them due to unpaid claims.

“I refuse to allow these kiddos that desperately need our care to suffer by discharging them,” Barnett said. “Instead, I will muster up my resources and hold Point32 accountable on behalf of, not only the Point32 covered kiddos in my care, but the Point32 kiddos with autism all over the country that may not have the resources [that] I do to fight.”

Allegations of a Ghost Network and Barriers to Autism Therapy

The lawsuit also accuses Point32Health of maintaining an inaccurate provider directory, creating a misleading perception of available care. This is a common issue in behavioral health, where autism therapy insurance disputes often stem from insurers claiming to have sufficient provider networks when, in reality, families struggle to find care.

Industry research shows that health insurance directories can be highly inaccurate. One study found that only 16% of listed behavioral health providers had correct phone numbers, and less than 18% of clinicians listed as in-network for Medicaid could provide new patient appointments. The lawsuit claims that Point32Health’s directory is part of a larger pattern of obstructing access to care.

Point32Health has previously acknowledged challenges in behavioral health access. In 2024, it introduced a care navigation program aimed at assisting members in finding available providers. However, ABA Centers of America argues that this effort does not address the real issue—the insurer’s failure to reimburse providers fairly in this autism therapy insurance dispute.

Legal Implications and Industry Impact

The lawsuit alleges violations of state laws, including promissory estoppel and unjust enrichment. Because ABA Centers of America often provides care on an out-of-network basis, it claims that Point32Health is still obligated to reimburse covered services. The provider argues that the insurer’s refusal to process payments has placed unnecessary financial strain on providers while limiting access to care.

This autism therapy insurance dispute has significant implications for children who require ongoing support. The lawsuit details seven unnamed pediatric patients who receive treatment from ABA Centers of America, each requiring intensive services for severe issues like self-injurious behavior. The provider claims that Point32Health is aware of the shortage of in-network providers but continues to delay payments for out-of-network care.

“Rather than honoring its obligations to its members and ensuring access to medically necessary care, Point32 withholds reimbursement, forcing Point32 subscribers and plaintiffs into an untenable position,” the lawsuit states. “This behavior not only jeopardizes patient care but also places an undue financial burden on providers and Point32 subscribers.”

The lawsuit also asserts that since ABA Centers of America’s claims have not been officially denied, the Employee Retirement Income Security Act (ERISA)—which governs many insurance disputes—does not apply. This makes it more difficult for providers to appeal unpaid claims, further complicating the autism therapy insurance dispute.

ABA Centers of America’s Rapid Growth and Fight Against Insurers

ABA Centers of America has experienced massive growth since its founding in 2020, ranking No. 5 on the Inc. 5,000 list of fastest-growing private companies in the U.S. Over a three-year period ending in 2023, the company’s revenue surged by 32,192%, making it one of the top health services organizations in the country.

Now, with its legal battle against Point32Health, ABA Centers of America is taking a strong stand in this autism therapy insurance dispute. The case could set a precedent for how insurers handle reimbursement disputes with autism therapy providers and other behavioral health organizations.

Point32Health has not yet commented on the lawsuit, but the case is likely to draw significant attention. As demand for autism therapy continues to rise, disputes like this one highlight the challenges providers face when dealing with insurers that delay or avoid payments. The outcome of this autism therapy insurance dispute could have lasting effects on access to autism care nationwide.