Elevance Health has filed a lawsuit against autism-therapy provider Perfect Child. The insurer alleges the company misled it over $160 million in claims. The suit claims Perfect Child used limited liability companies to charge out-of-network rates.
The complaint centers on how the provider structured its billing. Elevance says the company created LLCs to bypass network agreements. Those entities allegedly allowed Perfect Child to bill at higher out-of-network rates.
Autism therapy often involves intensive, long-term care. Insurers typically pay less for in-network providers. Out-of-network billing can raise costs significantly for payers.
The lawsuit adds to growing scrutiny of autism-therapy billing practices. Insurers have raised concerns about unusual corporate structures in the sector. Providers argue such arrangements are lawful and expand access to care.
Perfect Child has not publicly responded to the allegations. The case will likely hinge on whether the LLC structure was used to deceive the insurer. Elevance seeks to recover the alleged overpayments.
The dispute highlights tensions between insurers and autism-care providers. Families often rely on these services, making billing conflicts especially sensitive. Both sides face pressure to balance cost control with patient access.
The outcome could influence how other autism-therapy companies structure their operations. Insurers may tighten oversight of out-of-network claims. Providers may review their billing models to avoid legal risk.
