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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.
Headway cut therapist pay up to 30% on Jan. 1, 2025 — one 45-minute session fell from $144.27 to $103, per ClearHealthCosts. Aetna cuts Alma rates July 15, 2026.
62% of psychologists who left or never joined insurance networks cited administrative issues as the reason, per the APA — the 53-minute hour is what's left over.
In 2026, Georgia fined insurers nearly $25 million for mental health parity violations and collected $0. For insurers, the coverage gap is the product.
SAMHSA's 2023 survey found Cluster A personality disorders are among the least-engaged in outpatient care — schizoid traits don't complain loudly enough to be seen.