PsychBilling Coach

05/26/2026

Last week, Alma announced devastating reimbursement decreases for clinicians accepting Aetna through their platform.

What significance does this now-viral announcement have for the industry as a whole?

Why would this happen in an era of so-called "therapist shortages?" (Meaning a shortage of therapists who can or will accept low insurance reimbursement).

Particularly from a platform whose stated mission has always been to increase access to care?

Is Aetna really to blame? Or, is this a calculated gamble by Alma and their new owners, Spring Health?

I don't have the answers, but I do have some reasoned speculation. Read and find out what the possible future might hold!

https://psychbillingcoach.com/news/aetna-alma-therapist-shortage/

05/21/2026

Just when you think you've heard it all from insurance...!

I received a text from a client of mine going through an appeal. Appeal manager calls her and says "box 41 on the claim form was blank."

My response: "yes, I'm sure it was, since claim forms only have 33 boxes."

(True story!)

05/08/2026

Are you wondering what this craziness is about something called a "HETS attestation" for Medicare eligibility and a deadline this coming Monday?

Read this, if you submit Medicare eligibility inquiries through your EHR/clearinghouse. Failure to jump through this hoop will result in your eligibility access being cancelled. 👎

Your clearinghouse may have been bugging you for the last month about a deadline on May 11, 2026, with respect to Medicare eligibility and something called

04/29/2026

Connecticut therapists!!! Now's your chance to step up and demand better reimbursement.

The state has taken action and fined not just Aetna, Cigna, and United for parity violations, but also Anthem & ConnectiCare.

If you're being underpaid, there's no better time than right now to do a dive into the price transparency files, see how you stack up against others in the network in your market, and demand better. Parity and the state is on your side, and timing matters with these requests.

"According to the report, these carriers had "non-comparable and inadequate [mental health and substance use disorder] networks because of more stringent and limiting reimbursement rate structures demonstrated through disparate reimbursement rates, disparate out-of-network utilization rates, disparate new patient acceptance rates and disparate patient wait times."

Contact me if you need any help. And please repost to your colleagues so the word gets out to Connecticut clinicians.

Connecticut Insurance Department cited five major insurers — Aetna, Anthem, ConnectiCare, Cigna, and UnitedHealthcare — for failing to provide mental health and substance use coverage equal to their medical and surgical benefits.

03/19/2026

I needed to call out a few things. And if I'm naming and shaming, well, the truth is what it is. I said what I said.

The system is exploitative and consequences aren't assessed fairly. The longer this goes on, the worse things will be for us all.

Battling insurance probably never was anyone's idea of fun. But these days, we're all exhausted from constant systemic accountability failures: insurance

03/02/2026

Thank you Senator Warren!!!

What can we do to make breaking up vertical integration a reality?

Mental health clinicians: we're not exempt here and it's in our interest to support this. Most insurance companies have invested in one or more of the venture capital telehealth platforms.

The Break Up Big Medicine Act is a huge step toward fixing US Healthcare. Thanks to Elizabeth Warren for visiting the Glaucomflecken Cinematic Universe!Learn...

02/13/2026

Untangling the Medicare Participation Dilemma!

If you missed it a few weeks ago, you'll have another chance to catch me live. This coming Thursday, 2/19/26, at 3 pm central time.

Register for the live conference or to watch recordings of all 30+ speakers for just $99 for an individual, $299 for a team of 10, or $29 for grad students a...

02/13/2026

How Much Is Enough?

A look at 2025's Big Insurer profits - and what's really going on here.

https://psychbillingcoach.com/news/2025-insurance-profits/

01/06/2026

In mental health private practice, reimbursement rate mysteries plague us all:

*The insurance company won’t tell me what their reimbursement rates are until after I’m credentialed and signed the contract! So how do I decide if I want to join?

*Many of my clients need to use insurance. If only I could negotiate a reasonable reimbursement rate! I hear stories that some professionals get better rates, but I can’t figure out how!

*I can’t find/wasn’t sent a contract with a fee schedule! Or, over the years insurance panels updated my rates. But they don’t send notices of updates anymore. Sometimes they merged with another company and it’s not clear if I’m getting paid what I should be. Can I find out if I’m being underpaid?

*I’m a group practice owner. The venture-capital platforms are killing my business because they can pay better and credential much faster. Is the same procedure delivered through a platform really worth so much more than what my group is reimbursed? I can’t even effectively advocate for my group because I don’t have the reimbursement data! I don’t know how much of a raise I can get away with asking for.

What if you could discover what insurance pays everyone in your market for the same CPT code?

https://psychbillingcoach.com/end-reimbursement-rate-mysteries/

11/20/2025

Ensure profitability in 2026, starting at your front desk - even if that's a virtual desk!

Plus other news in the crazy world of mental health revenue cycle management:

-Availity Insanity
-Illinois rocks mental health parity!
-Badass executive complaint letters
-Following the tech platform money trail
-Blue Shield of California divorces Magellan: what you need to do NOW!
-Medicare whiplash!
-Medicare Advantage, as taught by John Oliver

https://news.psychbillingcoach.com/emails/webview/846795/171598432749749450