A New Jersey woman took her son to an autism-therapy provider that assured her she'd owe little or nothing. Her insurer balked. Then the bill came: $911,000. She isn't alone. The FBI is now investigating the provider, the Perfect Child, over billing that could top $30,000 a day and aggressive efforts to collect alleged debts from families.
The pattern, as the Journal describes it, is the same each time. The provider assured patients they'd face little or no out-of-pocket cost. It charged very high rates. Then it collected, sometimes through lawsuits. A Tennessee mother got a bill for nearly $1.5 million. With it came a demand. Sign over power of attorney so the company could sue her insurer in her name, or face legal action for the full amount. She declined but kept using the service because she couldn't find another provider in her rural area.
Why the bills got so big
The key fact is in the fine print of how insurance works. The Perfect Child didn't participate in most insurers' networks. When a provider is out of network, no contract governs its rates, so there's no agreed ceiling. In some cases, the company billed for services parents say weren't provided. Spending on this therapy, called applied behavior analysis or ABA, has soared, reaching $10 billion in 2025 from $2 billion in 2021 by a federal count. In many states, ABA companies face little oversight and few barriers to entry. One collections manager even threatened to open an FBI case against a parent who didn't pay nearly $20,000 by the end of the week. The real FBI is now looking at the company, not the families.
The company kept operating and suing. It sued at least five families last week. A congressional committee has also asked it for documents about its billing.
Our read
This is a Consumer Protection story, module M11, and it's the scariest kind, because it targets parents who will do anything for a child and can't shop around. The trap has one hinge: out-of-network care with no contract to cap the price. That's not unique to autism therapy. It's how surprise bills happen in emergency rooms, with anesthesiologists, with any specialist a hospital uses but your plan doesn't cover.
Here's the protection, and it's the same in every case. Before care starts, get two things in writing. First, is this provider in my plan's network? If the answer is no, that alone is a reason to pause, because an out-of-network provider can bill you the difference between its rate and whatever the insurer allows. Second, what is my expected out-of-pocket cost, in dollars, confirmed by my insurer, not by the provider? A provider's promise of little cost is not binding. Your insurer's written estimate is what counts. If you're ever handed a huge bill, don't sign anything that assigns your rights or grants power of attorney. Ask your state insurance department about balance-billing protections. We can't give medical advice, but we can help you read a plan's network and out-of-pocket rules before a big course of care. That's a fifteen-minute conversation that can save a family from the headline above.