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Filtered field notes — behavioral health policy.

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Tag · behavioral health policy
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All behavioral health policy posts.

Sorted newest first. Each post links primary sources and methodology.

insurance downcoding

The Invisible Pay Cut: How Insurers Downcode a Therapy Session Without Denying It

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.

Jul 20, 2026 Matthew Sexton, LCSW
commercial insurance

Same Session, Same Insurer, 7x the Pay: The Black Box in Commercial Therapy Rates

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.

Jul 20, 2026 Matthew Sexton, LCSW
Optum

Optum Is Not Your Insurer's Partner, It Is Your Insurer

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.

Jul 06, 2026 Matthew Sexton, LCSW
network adequacy

Network Adequacy Rules Tighten for 2026: The 10-Day Rule

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.

Jul 06, 2026 Matthew Sexton, LCSW
mental health data ownership

Mental Health Data Ownership: Who Should Own Your Therapy Data?

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.

Jul 06, 2026 Matthew Sexton, LCSW
mental health parity

Therapy Pays 22% Less Than Medical Care. Here's the Math.

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.

Jul 06, 2026 Matthew Sexton, LCSW
mental health insurance claim denials

Mental Health Insurance Claim Denials: 85 Million in 2024

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.

Jul 06, 2026 Matthew Sexton, LCSW
prior authorization

EviCore: The Invisible Gatekeeper Behind Prior Authorization

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.

Jul 06, 2026 Matthew Sexton, LCSW
mental health access

Why Is Therapy So Hard to Get? "Just Go to Therapy" Is Broken

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.

Jun 22, 2026 Matthew Sexton, LCSW
prior authorization

Prior Authorization: How Insurers Weaponize Mental Health Care

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.

Jun 22, 2026 Matthew Sexton, LCSW
mental health system

Mental Health System Broken? The Business of Being Unwell

In 2026, Georgia fined insurers nearly $25 million for mental health parity violations and collected $0. For insurers, the coverage gap is the product.

Jun 22, 2026 Matthew Sexton, LCSW
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