A flagship moment on this theme
"I just think about all the aces work that's been done to show how much trauma impacts physical health. Right. Not just the two are not separate, they are very interrelated. And if you're treating trauma, if you're treating mental health, then you're also seeing benefits to physical health."
Connects the policy conversation to TSTI's clinical core. This is the moment where a parity episode becomes directly relevant to trauma-specialized clinicians and the downstream argument for why behavioral health investment produces physical health returns.
Where this is a central topic
17 episodes
Community Health, Local Solutions with Malcolm Furgol
The episode's central problem: low reimbursement rates, insurance clawbacks, and administrative complexity are named as the structural reasons providers opt out of accepting insurance, with both Rachel and Malcolm returning to this repeatedly.
Out‑of‑Pocket and Out of Reach
Rachel names the core tension explicitly: providers can no longer afford low reimbursements while clients can no longer afford out-of-pocket rates, widening the gap from both ends.
Interstate Licensure Compacts
Rachel returns to this repeatedly: even when clinicians can legally practice across state lines, insurance coverage, parity, and reimbursement rates remain unresolved and vary by state and plan type.
Inside Behavioral Health Systems with Cathy Gilbert
The Optum, Humana at Walmart, and CVS clinic models are examined at length, with Kathy acknowledging the access rationale while naming the core limitation: they redistribute existing providers rather than create new capacity.
Why Value-Based Care Can Feel So Hard with Josephine Wilton, Pt. 2
Josephine walks through specific contracting mechanics: hidden reimbursement structures, amendment review, and why consistent revenue does not mean a practice is being paid what it agreed to.
Understanding Mental Health Parity with Deborah Steinberg
Reimbursement rate disparities, prior authorization inequities, day limits, coverage exclusions, and RTI International study data showing same-code pay gaps between mental and physical health providers are discussed throughout.
Viewing Mental Health Care Through a Family Systems Lens
Covered in depth across multiple sections: reimbursement rate mechanics, clawbacks, network participation decisions, parity gaps, and the cycle by which provider charges influence what insurers pay.
Policy Shifts Reshaping Mental Health Care with Cathy Gilbert
Cathy describes provider rate reductions as a near-certainty and raises alarm that mental health has historically been the lowest-reimbursed specialty, making further cuts potentially unsustainable for many practices.
When AI Meets Therapy: Risks, Ethics, and Advocacy with Dr. Ajita Robinson
The second half focuses on insurance companies freezing rates for eight years, a 17% provider reimbursement decrease reported by CMS, and the Headway-CareFirst arrangement as a potential antitrust violation.
Strategy, Not Panic with Jeremy Zug
Rate cuts, the Carillon 40-57% reduction in Indiana, prior authorization reform, out-of-network strategy, and the negotiating position of independent practices were the primary threads running through the episode from start to finish.
Welcome to the New Chapter of the Podcast
Rachel details the specific payment mechanics at work: insurance companies paying tech platforms more per session than independent providers, and creating their own clinics that waive copays.
Supporting the ALICE Community | Alison Pidgeon of Move Forward Counseling
High-deductible plans blocking therapy intake, copay assistance programs as a practical workaround, and Alison's proposal for an after-hours pay differential code are all discussed at length.
Advocating for Mental Health Insurance Reform | Lisa R. Savage of the Center for Child Development
The episode's primary spine: credentialing delays, a $25,000 clawback over documentation gaps, an unannounced mid-session records demand, and the Change Health hack that left Lisa unable to pay employees all illustrate the operational weight insurance places on group practices.
Current Challenges and Innovations in the Mental Health Field | Check-In with Rachel Harrison
Rachel spends a substantial section on how insurance design specifically blocks creative modalities, citing neurofeedback's underpayment and equine therapy's non-coverage as concrete examples.
Proactively Addressing Mental Health | Rachael Bevilacqua of Sanare Today
Rachel Harrison explicitly names the diagnosis-first billing requirement as the structural barrier to preventive care, and Rachael Bevilacqua raises the idea of a CPT code not tied to diagnosis as a possible workaround.
Making Value-Based Care Work with Josephine Wilton Pt. 1
Claims processing delays, billing system configuration, payer-provider contracting dynamics, and attribution rules are all examined as direct drivers of VBC success or failure.
Big Mental Health Stories & Trends to Watch in 2026
Rising premiums, falling provider payouts, and increasing member cost-sharing are framed as converging pressures threatening both client access and practice viability.
Where this comes up substantially
13 episodes
Rethinking Behavioral Health Access with Jason Youngblood
Jason addressed the gateway vs. gatekeeper framing directly, arguing Cigna's current philosophy is about removing barriers rather than managing utilization, and acknowledged that frustration with the industry is well-earned in many cases.
Technology, Therapy, and the Future of Care
Rachel discusses how low reimbursement rates, high administrative burden for Medicaid and Medicare, and the economics of private pay create structural access gaps that the provider shortage narrative tends to flatten.
The Future of SMI Treatment with Dr. Scott Feers
Cost savings from early intervention and AI efficiency are discussed, and Dr. Fiers closes the episode by naming fee-for-service reimbursement as the structural block on scaling these innovations.
AI and Measurement-Based Care with Dr. Dylan Ross
Payer data gaps, 20-30 percent premium reimbursement for aggregators, and the mechanics of alternative payment models are discussed with specificity from Dylan's time leading Optum's high-performing networks team.
Private Equity in Mental Health Care with Dr. Jane Zhu
The episode examines how insurance complexity drives clinicians toward cash-pay models and how PE acquisition correlates with higher negotiated prices and volume pressure on providers across multiple studies.
Nonprofit Efforts for Teen Mental Health | Chea Weltchek of Teens with Trauma
Both host and guest discuss the specific ways insurance fails teens seeking trauma therapy: session limits, high deductibles, copays that make consistent attendance impossible, and outright exclusions on intensive trauma modalities.
IV Ketamine-Assisted Psychotherapy | Will Ratliff of Transcend Health Solutions
KAP lacks a specific CPT code, mental health indications remain off-label, and Will names the pharmaceutical lobbying dynamic that keeps this treatment uncovered despite strong evidence, creating a structural billing barrier specific to novel modalities.
The Immersive Power of Virtual Reality Therapy | Dr. Kryn McClain of CatapalloVR
Rachel raises the difficulty of insurance-based practice and McClain addresses how therapists bill for VR sessions using standard CPT codes, backed by a 400-page intervention documentation library she built to satisfy insurer scrutiny.
Using Brain SPECT Imaging for Mental Health Treatment | Dr. Rishi Sood of the Amen Clinics
SPECT imaging is not covered by insurance, and Dr. Sood identifies this alongside Big Pharma's investment in DSM-based categorical drug matching as the two structural forces keeping brain imaging out of mainstream psychiatric care.
Making Self-Help Resources Accessible to All | Diana Partington of the Book, DBT for Life
Diana outlines her tiered content pricing model (groups, webinars, free podcast, $30-range book) as a practical response to the affordability problem, and briefly references a prior podcast guest's point that clinicians should not apologize for making money.
Psychotherapy with Horses | Rosemary Baughman of Courageous Hearts
Rosemary explains the core billing problem directly: insurance only reimburses the mental health clinician, not the equine professional, making the co-facilitation model financially unsustainable without state contracts and nonprofit funding.
The Relationship Checkup with Dr. James Cordova and Matt Rubin of Arammu
Rachel raises the identified patient problem, and Dr. Cordova describes the billing codes and state-level annual mental health checkup coverage that makes the model viable.
Virtual Worlds, Real Skills with Dr. Kryn McClain
Dr. McClain addresses CPT code use for VR sessions and describes building a 400-page documentation resource so therapists can justify VR use to insurers.
Mentions
4 episodes
Mentions
4 episodes
Proactive Relationship Healthcare | Dr James Cordova and Matt Rubin of Arammu
Rachel and the guests briefly cover billing codes for annual checkups, the identified-patient requirement for couples billing, and the out-of-pocket cost comparison to asynchronous mental health apps.
Healing the Body, Healing the Mind | Samantha Rodriguez and Stephanie Dunker of ATI Physical Therapy
Briefly mentioned — some insurance plans require a physician referral before covering PT, which creates a partial access barrier even in a direct-access state.
A Creative Approach to Grief Support | Jamie Eaton of Living Through Loss
Mentioned as a barrier to EMDR referrals — families in the community can't always access individual EMDR because of coverage gaps and provider shortages.
Wrapping Up 2024 and What's Next for the Podcast
Insurance companies named alongside tech companies as a stakeholder perspective Rachel wants to platform in the upcoming rebrand of the show.
Looking to go deeper in your own work?
These TSTI trainings build on conversations from the episodes above.