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Twelve insurance-affiliated companies now own CAQH, the credentialing database nearly every therapist updates for free, after a January 6, 2026 restructuring that put a UnitedHealth Group executive in the board chair seat. The rebrand to DataSpring changed the name. It did not touch the ghost-network problem the database was supposed to solve.
For the exact same hour of therapy (CPT 90837), commercial negotiated rates run from $78 to $542, median $147 — and inside a single carrier, UnitedHealthcare, psychotherapy rates vary by up to 7x (Trilliant Health, 2026). A rate the clinician can't predict and the employer can't audit isn't a glitch. It's the design.
A commercial insurer doesn't have to deny a therapy claim to cut the pay. It can pay the claim and quietly reclassify a 53-minute session down to a shorter, cheaper code. In 2026 the longer 90837 session commonly pays 15% to 25% more than the shorter 90834, and Cigna began downcoding certain visits automatically on October 1, 2025. There is no denial, so there is nothing to appeal.
A company most patients have never heard of makes coverage decisions for about 100 million insured Americans — 1 in 3 people with insurance — across 100+ insurers.
States screened 793 AI health bills; only 28 mentioned mental health, and none protect your therapy transcripts. Here is who owns your data today, and who should.
Insurers denied 19% of in-network claims in 2024 — about 85 million. Fewer than 1% were appealed. Reviewers who re-checked denials overturned six in ten.
Marketplace plans must offer a routine mental health appointment within 10 business days, 90% of the time — and New York's rule now hits most commercial plans.
UnitedHealthcare pays Optum-owned practices 17% more than nearby practices, and up to 61% more where it dominates the market. Same parent company, both sides.
Medical and surgical visits pay clinicians 22% more than mental health visits on the same commercial insurance plan — 70% more at the top of the pay range.
In 2026, Georgia fined insurers nearly $25 million for mental health parity violations and collected $0. For insurers, the coverage gap is the product.
79% of physicians say prior authorization can push patients to abandon treatment. In mental health, the paperwork isn't a side effect of coverage. It's the point.
137 million Americans, 40% of the country, live in a mental health workforce shortage area as of March 2026. This is the architecture behind why care is hard to get.