Understanding Changes in Therapy Coverage and Access
Balancing Affordability, Access, and Quality Care
I believe therapy should be accessible to everyone who needs it. That’s why I continue to accept insurance – even as doing so becomes increasingly challenging to sustain. I want to be transparent about what’s happening behind the scenes, because these changes ultimately affect the care you receive.
Over the past several years, the cost of nearly everything has gone up: rent, professional liability insurance, clinical supervision, software, continuing education, and the basic tools therapists need to run a practice. And yet, while prices rise for everyone, mental health therapists stand in the extraordinary position of being one of the only healthcare professions experiencing actual payment reductions from insurance companies. Unlike other medical providers whose reimbursements typically see at least modest annual increases to account for inflation, therapists’ rates have been actively cut year after year. This troubling trend continues even as insurance companies post record profits. Many therapists now receive lower payments in 2025 than they did five years ago, despite facing significantly higher operating costs—creating an unsustainable situation that threatens access to care.
Recent reporting highlights how insurers like UnitedHealth/Optum are reducing rates for therapy while reporting billions in revenue. These decisions aren’t small adjustments – they represent substantial cuts that impact how I can deliver care to you. For more information:
• Insurers’ wide payment reviews drive therapy practices to despair (March 2025)
• UnitedHealth/Optum pay cut makes clinicians reassess value of tech mental health platforms (Nov. 2024)
• 2 digital mental health platforms cut pay rates for therapists, stirring anger (Nov. 2024)
How This Affects Your Care
These insurance practices affect more than just finances – they impact the therapeutic relationship we build together. To bill insurance, I am required to:
- Provide a mental health diagnosis, even when you might be seeking therapy for personal growth
- Regularly document and justify that your therapy is “medically necessary”
- Limit the length or frequency of our sessions based on insurance preferences rather than clinical need
- Submit to audits where confidential session notes can be reviewed
Insurance companies also reserve the right to deny coverage retroactively (going back years), and demand repayment for services already provided. This uncertainty can create stress for both of us and interferes with the privacy and integrity of the therapeutic process.
When I am required to focus on paperwork and insurance requirements, that’s time taken away from focusing on your care and my professional development to better serve you.
Advocating for Standard Therapy Practices
For generations, therapy has followed a fairly consistent structure – most clinicians are trained to provide hour-long sessions (typically 50–60 minutes), which has long been the standard of care. However, insurance companies are now challenging even this basic aspect of treatment.
Companies like Blue Cross Blue Shield are flagging longer sessions – specifically those billed under CPT code 90837 (53+ minutes) – as “excessive.” These sessions are frequently audited or discouraged simply because they reimburse at a slightly higher rate than shorter ones (CPT 90834, which covers 38–52 minutes). This approach isn’t based on clinical guidelines – it’s a cost-cutting measure that can affect the depth and quality of our work together.
There is no legitimate clinical justification for calling a 53-minute session “extended.” Yet this pressure to shorten sessions means we may have less time to work through complex issues that require more than a quick check-in.
Understanding Insurance Company Practices
Below is a comparison of major U.S. health insurance companies based on recent data regarding CEO compensation, company profits, and how they approach mental health coverage:
| Company | CEO & Compensation | Profit (Most Recent Year) | Impact on Mental Health Care |
|---|---|---|---|
| UnitedHealth Group / Optum | 2023: ~$20.9 million | $8.1 billion profit in Q1 2024 alone; $22 billion+ expected in 2024 | Reduced therapist reimbursement while posting record profits; subject of clinician advocacy efforts |
| CareFirst BCBS (Nonprofit) | ~$6 million in 2022 | Not-for-profit; holds $3+ billion in reserves | Maintains large executive compensation and reserves despite nonprofit status; increasing premium costs |
| Evernorth / Cigna | Cigna CEO: $20.9M in 2022 | Evernorth: $44.9B revenue, $1.9B earnings in Q1 2024 | Increasing earnings from mental health services while reducing provider rates |
| Anthem / Elevance Health | $21.3 million in 2023 | $6 billion profit on $156.6 billion revenue (2022) | Shifted focus from healthcare delivery to broader “health solutions” |
| Aetna (CVS Health) | CVS CEO: ~$21.3M in 2022 | CVS Health (parent): ~$8.3 billion profit in 2023 | Implements strict restrictions on therapy session length and utilization |
Moving Forward Together
I continue to accept insurance because I care about making therapy accessible. However, I’m also thoughtfully considering how to transition toward a model that allows me to provide care based on your clinical needs rather than insurance company policies.
If you’re currently using insurance, please know that I’m committed to supporting you through any transitions. I’m happy to discuss options including:
- Sliding scale fees based on financial need
- Assistance with out-of-network reimbursement
- Exploring whether your HSA/FSA funds can be applied to therapy
- Finding a schedule that works with your budget while meeting your clinical needs
Understanding Out-of-Network Coverage
If we transition to out-of-network care, you would pay for sessions directly and then submit claims to your insurance company for potential reimbursement. This typically requires understanding your specific plan coverage.
For example, if your plan states they cover 80% of out-of-network costs, they typically mean 80% of what they’ve determined to be “reasonable and customary” for therapy in our area. As of January 2025, according to Fair Health Consumer, the average therapy cost for Northern Virginia is $148 for in-network providers and $201 for out-of-network providers. Current insurance reimbursement to therapists averages between $109-$121 for a 53+ minute session.
Let’s Talk About Your Care
If you have questions or concerns about how these insurance changes might affect your therapy, please bring them up during our next session. My priority remains providing you with the highest quality care possible, and I’m committed to working together to find solutions that support your mental health journey.
Transparency about these challenges is one way I advocate for both my clients and the profession. Thank you for your understanding as we navigate these changes together.