For employers, plans and advisors
You've uncovered the costliest conditions. What else is hiding in your population?
Cancer. Musculoskeletal. Mental health. The conditions you already track are the ones your analytics can see. Undiagnosed genetic disease in children is spread across neurology, GI, behavioral health, emergency and pharmacy, and no single code names it.
One member on one plan
A treatable metabolic condition, missed for years.
The member had uncontrolled seizures and a record of repeated ineffective treatments. Sunstone identified a biotinidase deficiency the system had missed, and the seizures resolved.4
A treatable metabolic condition, missed for years, paid for by the plan the entire time. That case is already somewhere in your claims data.
Audit finding
ABA therapy: the cost driver no one is auditing.
Autism therapy claims are one of the fastest-growing cost drivers in employer health plans, and the only payer that has actually audited them found a problem in every single sampled month reviewed.
-
100%
of sampled enrollee-months in a 2026 federal audit contained an improper or potentially improper payment. $42.6M confirmed and $112.5M potentially improper in a single state.1
-
Among the highest
per-child annual costs of any pediatric benefit a plan carries, with hours frequently set without a defensible clinical basis and a routine driver of stop-loss claims.
-
175%
increase in ASD diagnosis rates across U.S. health systems since 2011, from 2.3 to 6.3 per 1,000 members.2
The diagnostic odyssey
Six years of spend with nothing to show for it.
-
Years of tests and specialists, no resolution
A diagnostic odyssey that averages more than six years, while cost accumulates across every specialty it touches.3
-
Unexpected time away for caregivers
Unplanned absence, disrupted focus, and reduced productivity at work, carried by your employees.
-
A toll that never reaches a benefits report
Stress and anguish for families facing no answers, and children losing years of childhood to the search.
Sunstone finds what other programs miss.
We reduce a child's diagnostic odyssey from years to twelve weeks using precision data, medicine and treatment plans that address hidden, high-cost members, including those with an ASD diagnosis and those receiving ABA therapy.3
Autism is one word describing hundreds of distinct biological diseases. Without genetic testing, the children in your plan who can benefit the most are the hardest to see.
Sunstone does the work. You stay informed without taking on the burden.
From your claims data to a care plan for each family, with reporting back to you at every stage.
Fifteen minutes is enough to know whether this fits your book.
Bring your claims profile. We'll tell you what we would expect to find in it, and what it would cost to find out.
Sources and important information
-
HHS Office of Inspector General, report A-09-24-02004, issued 25 February 2026. All 100 sampled enrollee-months in the Colorado audit included payments for one or more claim lines that were improper or potentially improper: $42.6 million confirmed improper and $112.5 million potentially improper, both federal share. Fourth in a series covering Maine, Wisconsin and Indiana. This is Medicaid fee-for-service in audited states, not commercial plan experience.
-
Grosvenor LP, et al. Autism Diagnosis Among US Children and Adults, 2011-2022. JAMA Network Open 2024;7(10):e2442218, covering 12.3 million members across 12 health systems in the Mental Health Research Network. The 175% figure is the full-sample increase across all ages, and most of it reflects adults being diagnosed later rather than rising incidence in children. For context, CDC ADDM reported autism prevalence among 8-year-olds at 1 in 31 in April 2025.
-
Twelve weeks describes the Sunstone pathway from intake to delivered care plan and is not a guarantee of timing for any member. The six-year figure is the published average diagnostic odyssey for rare disease — 6.3 years and 16.9 specialists, EveryLife Foundation for Rare Diseases, 2023 — and is not a measurement of any individual practice. Sunstone does not guarantee that a genetic finding will be identified or that a particular test will be ordered. All clinical decisions belong to the physicians of Sunstone Clinical, PC.
-
A single case. Sunstone identified a biotinidase deficiency in a member with uncontrolled seizures and a record of repeated ineffective treatments, and the seizures resolved. Cost figures for this case are being substantiated and are not published here. Individual results vary and a single case is not a projection of plan-level savings.
Employers and plans receive de-identified cohort reporting. Member-level clinical data never leaves Sunstone Clinical, PC. Sunstone is not an insurance product. Read the full disclaimer.