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
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Tag · health insurance
All health insurance posts.
Sorted newest first. Each post links primary sources and methodology.
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
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: 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
Insurance Credentialing: The 90-to-120-Day Limbo
A licensed therapist can wait 90 to 120 days before an insurer lets them bill, per the AMA. That wait thins networks and breeds the ghost networks patients hit.
Jul 06, 2026 Matthew Sexton, LCSW
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
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 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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