Many families are on the fence about the merits of ABA.

Carolina Lopez no longer is.

When her son Ezekiel was diagnosed with autism at age 3, she did what any of us would do — she went looking for help. She called provider after provider. Every one had a wait list. "There seemed to not be much I could do," she told The Wall Street Journal.

Then a company in Brooklyn called the Perfect Child promised her two things she desperately needed: immediate treatment, and no out-of-pocket cost.

Workers came to her New Jersey home several times a week, spending three to four hours with Ezekiel — puzzles, educational toys, etc.

In April, she got the bill.

$911,400.

That was no typo. Nearly a million dollars, addressed to a bank employee and mother who had been told there would be no cost at all. Weeks later, a second bill arrived. The amount had grown to $916,000. Then a debt collector called.

Unfortunately, it’s not so puzzling how something like this can happen — how a parent seeking therapy for a toddler could end up owing more than most homes cost. It’s not a story about one bad company.

It’s a story about a system practically designed to produce them.

Every provider Carolina Lopez called had a wait list. Except for an ABA provider in Brooklyn called A Perfect Child.

Their website, in bold letters, shouts on its homepage: "We Have NO WAITLIST For Services!" Home-based and community-based therapy, evenings and weekends, available now.

Its insurance page goes further, promising a financial assistance program that "can reduce co-payments to as low as $0."

To a parent who's been told to wait years for help, that's a lifeline.

And that's the trap. According to The Wall Street Journal, the same company offering instant, no-cost relief was billing insurers as much as $436 a minute — then pursuing families for hundreds of thousands of dollars when insurers refused to pay.

Let's start with how you get to $911,400 for sessions with a 3-year-old.

According to insurance records reviewed by the Journal, on August 18, 2025, a behavior technician spent a total of 70 minutes with Ezekiel — working on a puzzle and playing with educational toys.

For that day, the provider billed Ezekiel's insurer $30,500. To put that into context, a surgeon in New York City charges $8,000 for scoliosis surgery, according to the New York Times.

To further the point: the Journal reported the company billed health plans rates as high as $13,000 an hour — roughly 150 times the average rate paid to in-network providers. As one insurance executive put it, looking at the hours some providers claimed: "They'd have to be doing these services 24 hours a day, seven days a week."

The Perfect Child says on its website that it provides home-based autism therapy across roughly 30 states. The Journal tied it to more than 100 limited-liability companies — names like Kiedga LLC, Junior Boom ABA LLC, Cedar Eye Therapy LLC. Insurers told the Journal the tangle of company names makes the billing nearly impossible to track.

When Journal reporters knocked on the Brooklyn address listed in corporate filings, a man who appeared to be the founder denied being himself, said he couldn't help, and closed the door. The phone numbers were disconnected.

This is a systemic issue. Aetna reported that investigations finding likely fraud or abusive billing by autism-therapy providers rose 300% between 2024 and 2025. Highmark — Lopez's insurer — told the Journal that suspicious billings from out-of-network autism providers are "in the multimillion dollars." The Journal found 10 other families with five-figure surprise bills from the Perfect Child alone, and reported the company has sued at least 19 patients and employers since late 2024.

According to the Journal, the alleged abuses include billing for hours that never happened, billing for multiple services in the same hour, and claiming to provide care at home addresses that don't exist.

But here's the question that kept nagging at me.

Why was Carolina Lopez so desperate in the first place?

Because every legitimate provider she called had a wait list. Because the system that's supposed to help families like hers is starved — underfunded, overwhelmed, with too few providers and too many children waiting.

Into that gap steps the predator.

And this isn't unique to New York, or to ABA, although ABA providers have been singled out, politicized most notably in Minneapolis.

Right here in New York, special education attorney Marc Gottlieb describes a parallel dynamic that's helped balloon NYC's special education litigation costs into the billion-dollar range. The mechanism is chillingly similar: the city sets provider reimbursement rates so unrealistically low that few will answer the phone. Parents can't find a provider, sue, and win — and the law, Gottlieb notes, historically didn't even let a judge rule that a sky-high hourly rate was excessive.

Gottlieb's diagnosis of why this keeps happening is the most honest thing I've read on the subject:

Here's the thing: ABA is not the only option — and it's not for every child.

ABA (applied behavior analysis) is by far the most commonly prescribed autism therapy, often recommended at 40 hours a week, and frequently described as the "gold standard." The Perfect Child itself calls it "a highly effective and evidence-based approach." But that framing leaves out two important truths.

First: ABA is genuinely contested. Many autistic adults who went through ABA as children describe it as harmful — a system built around rewarding compliance and teaching kids to suppress their natural behaviors, or "mask." That’s been our family’s experience. ABA techniques of rewards for masking have led us down a spiral of dysregulation.

Other parents and clinicians say ABA helped their children communicate and thrive.

We don't have to take that on faith — parents say both things openly. In one Brooklyn parents' forum, a mother weighing providers wrote that a bad experience elsewhere "led to more in-depth research into ABA, and deciding it wasn't a fit for us."

Second: there are alternatives. One is Developmental, Relationship-Based Intervention (DRBI), also known as Floortime. Instead of rewarding compliance, DRBI builds on a child's own innate drive to connect and learn, tailoring play-based interaction to the child's profile and their relationship with caregivers. It also typically requires far fewer billable hours than ABA — which, notably, means less exposure to the kind of billing predators we just described.

Dr. Josh Feder, MD, executive medical director for DRBI provider Positive Development, describes the approach this way:

NYC families who want to explore DRBI can check out the website of Dr. Stanley Greenspan, the founder of Floortime: https://stanleygreenspan.com/

In New York, the private Rebecca School operates on a DRBI modality.

To be clear: some families report good experiences with the Perfect Child. In a Brooklyn parents' group, one mother wrote that her family had "a great experience," describing therapists that, in her words, "'get' my son." Another said they'd "seen amazing, life-changing results."

A provider can genuinely help one family and still, according to the Journal's reporting, operate a billing apparatus that financially devastates another family. The Journal's investigation is about the billing — not a verdict on every session delivered or every child helped. Both realities can be true at once.

That's exactly why parents need to go in with their eyes open.

The Lopez case offers a hard-won checklist. Before you sign anything:

Carolina Lopez said something that many parents can relate to:

She's right. But the predators are only half the story.

If this helped you understand something you didn't before, send it to someone who needs to see it.