Conversation 35 - Reclaiming Counselor Dignity: Insurance, Antitrust, and the Path to Equity - Ohio Counseling Conversations

Episode Transcript
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SPEAKER_00 (00:01):
Welcome back to Ohio Counseling Conversations, the
podcast of the Ohio CounselingAssociation, where we amplify
the voices shaping ourprofession.
Today we're diving into an issuethat impacts every counselor,
every client, and everycommunity in Ohio and beyond:
insurance reimbursement andprovider advocacy.
Counselors make up the largestsegment of the behavioral health

(00:21):
workforce, but we remain thelowest reimbursed compared to
psychologists, social workers,and marriage and family
therapists.
This isn't about competency,it's about systemic and legal
structures that undervalue ourprofession.
To help us unpack thesechallenges in the path forward,
we're joined by two members ofOCA's Insurance Advocacy
Committee.
They've been on the front linesof monitoring reimbursement

(00:44):
trends, pushing foraccountability, and helping
counselors understand what's atstake.
We'll talk about systemicdiscrimination in reimbursement,
barriers created by antitrustlaw, and why trade associations
and clinically integratednetworks may hold the key to
lasting change.
Most importantly, we'll explorewhy this fight is not just about
provider pay, but about mentalhealth equity and ensuring that

(01:06):
communities across Ohio havetimely, affordable access to
care.
We typically reserve a commonquestion for our guests at the
end of the episode about whatconversations counselors in Ohio
should be having with each otheror with their clients.
And today's guests made the casefor today's conversation.
So it's going to be our focustoday.
Today we are joined by MikeDespacito and Derek Lee from the

(01:28):
Insurance Advocacy Committee ofthe Ohio Counseling Association.
Gentlemen, thank you so much forjoining us today.
We're excited to have thisconversation.
Although, you know, fromspeaking with you, it might be a
little heavy, but it's animportant, meaningful
conversation.
But before we get to some ofthat, please share a little bit
about yourselves with ourlisteners.

SPEAKER_04 (01:48):
Yes.
So my name is Mike Desposito.
I am the current chair of theIAC committee for insurance
advocacy.
We call it AccountabilityCommittee.
And I also represent counselorson the Ohio Behavioral Health
Providers Insurance AdvocacyCommittee.
So kind of like the largerversion for all of the allied
fields.

SPEAKER_00 (02:08):
Wonderful, wonderful.
Thank you for joining us, Mikeand Derek.

SPEAKER_03 (02:12):
Yeah, my name is Derek Lee.
I'm a professor for Texas TechUniversity Health Sciences
Center.
And I've I've had practices inOhio for about 15 years now.
Ohio's where I've been for, youknow, I did grad school, and
having practices, insurance hasbeen a really key issue.
So that's how I got involved inIAC a half a dozen years ago.

(02:36):
It's really difficult to haveequitable health care for people
in Ohio if we don't have reallygood relationships working with
insurance.

SPEAKER_00 (02:47):
Wonderful.
Well, we're so excited to haveboth of you here today.
And to get us into thisconversation, Mike, can you
start us off and share like whyinsurance advocacy is such a
critical issue for counselorsright now?

SPEAKER_04 (03:02):
Yes, I find this is this is probably going to be a
heavy conversation becausereally what I'm noticing now is
counselors are caught in what Iwould say is a crisis of
imagination.
We have a sizable share of thebehavioral health workforce, and
yet the average counselor makessomething like$35,600 a year.

(03:26):
Whereas other, and that'sincluding that we have to
complete 60 credit hour master'sdegrees plus our internships and
supervision and so on.
When you add in then how othermaster's level professionals
command salaries of over$100,000, typically, it just
creates a major difficulty forus as counselors to survive.

(03:50):
And what really irritates meabout this is this isn't a lack
of competency.
The more I'm in this and themore we've been fighting for
insurance advocacy, what we havelearned is that there is a legal
systemic structure set up todisempower and strip us of our
inherent dignity as counselors.

(04:11):
And since I've assumed the roleas chair of the IAC, Derek was
originally the chair, so Iappreciate him for walking so we
can run now.
And now working with otherAllied professional counseling
associations and other groupsacross state lines, including
Kentucky and Indiana, we areseeing and have documented

(04:32):
moment after moment across thecountry where insurers are
slashing our provider rates androlling back payment increases.
So this isn't just a smallproblem, it's a national
problem.
That then creates a brokensystem that fuels burnout and
all the things we're talkingabout in our field.

(04:53):
And so, really, our goal todayfor this podcast is, and what I
want every counselor to know andto that's listening right now is
I want to start reimagining ourrelationship with insurance and
to begin building solidarityinstead of what we'll talk about
is we are really a patchwork ofoften competing providers and to

(05:16):
begin moving towards anintegrated solution to address
this problem.

SPEAKER_00 (05:21):
Yeah.
And like gentle plug, if you arelistening, like share this with
people because it is such ameaningful topic and so
important to the work that we doas counselors.
Now, counselors make up one ofthe largest groups of licensed
professionals in the behavioralhealth workforce yet.
Tend to be the lowest in rereimbursement rates.

(05:44):
And Derek, like from yourperspective, how did this
inequity come to be?

SPEAKER_03 (05:50):
Well, let's start with the difficult truth that's
essential in making this shift areality.
Counselors are good people andhelpers at heart, which
unfortunately sets them up to betaken advantage of.
We live and do business in aworld that's capitalistic,
meaning that it's based insupply and demand.
We've watched the world increaseprices and raise rates

(06:14):
dramatically over the lastseveral years, increasing the
cost of living all around us.
I actually pushed to increaserates as a profession during
COVID when our value was finallybeing recognized.
And our field told me that itwas unethical.
So to borrow Mike's phrase thatthis is a crisis of imagination
and disempowerment, it's beennormalized in how it undervalues

(06:38):
our profession.
We have to become more dynamicas a profession, not only as
counselors, but as businesspeople and participants in a
capitalist economy.
The way we approach business hasallowed for insurance companies
to treat us like vendors,driving down our price to
improve their margins ratherthan treating us like partners.

(07:02):
You know, we're struggling tosurvive in a system in which
we're the underdog.
And this position stems fromthose systemic and legal
inequalities that Mikementioned, not professional
competency.

SPEAKER_00 (07:18):
Yeah, crisis of imagination.
That's gonna be probably thetitle here, right?
Like, you know, we've seen sometroubling trends like across the
country, like you were saying,Mike, from Indiana's Anthem
Cuts, Colorado and KentuckyMedicaid rollbacks.
Which of these examples standout most to you?
And what are they revealingabout the systemic devaluation

(07:42):
of our counseling profession?

SPEAKER_04 (07:45):
Yeah, so this will likely be the hardest part of
this podcast to swallow.
And I want to shout out actuallyone of our key allies that I've
been working with here, which isthe mental health insurance
reform task force, which isstarted by uh founder Nicole
Sartini.
She's out in Kentucky.
In one year, she has now done somuch work between Kentucky and
Indiana and is one of the majortrailblazers who's really trying

(08:08):
to reimagine a lot of thisconversation.
It is because of her that wewere able to start combining
data on this.
And I think now we are overabout 19 pages of just
documented rate cuts across fiveyears.
So just to kind of maybesummarize quickly and then maybe
hit a few key ones, if you kindof summarize the last five
years, many of the cutstargeting everyday counseling

(08:32):
sessions or telehealth, theslashing reimbursement is around
25 to 40 percent in differentstates.

SPEAKER_02 (08:41):
Wow.

SPEAKER_04 (08:42):
And that makes up it nearly impossible, often for
small business practices to run.

SPEAKER_02 (08:49):
Yeah.

SPEAKER_04 (08:50):
California's one that I know was specific to
telehealth.
So for my telehealth counselors,there was an insurance company
that was private that attemptedto classify telehealth therapy
on a lower reimbursement rate,even though it violated
California's telehealth paritylaw.
And even with medicalintervention or intervention
from the California MedicalAssociation and clarification

(09:14):
from state regulators, thecompany finally reversed it.
But I just want to kind of drawa takeaway here, which is they
still attempted to change it.

SPEAKER_02 (09:25):
Yeah.

SPEAKER_04 (09:26):
Even with the law in place.
Ohio's the one that we'regetting a lot of right now.
I'm getting messages probablyweekly from counselors, where
there is this kind of scaryletter where we get from a
certain private insurancecompany that says we are
monitoring your CPT code use.
And we want you to know you'reoverutilizing the standard rate

(09:49):
and you need to consider downcoding.
That's one that we're talkingabout at the higher level of the
Ohio behavioral providers.
So allied fields are also seeingthe same thing.
Indiana, as you indicated, thatwas the most recent one that was
in the news where a privateinsurance company sought to
create a new fee schedule toreduce the standard 53 plus

(10:12):
minute session from$115 down to$65.
That insurance company did comeout, give them some credit.
They did come out and say it wasa miscommunication.
However, the letters do existand it was something that caused
a major uproar in Indiana.

SPEAKER_02 (10:28):
Yeah.

SPEAKER_04 (10:29):
This is not including the Medicaid changes.
Several states have alreadyrolled back Medicaid increases,
even though they promised themwith budget crises across the
nation.
Often you're seeing across theboard Medicaid cuts.
And it's not just that the ratesare being cut, it's these new
administrative hoops we'rerunning into that's also quietly
driving down lower reimbursementrates, which we'll talk about in

(10:50):
terms of down coding orclawback.
Other words we'll define later,I'm sure.

SPEAKER_01 (10:56):
Yeah.

SPEAKER_04 (10:56):
My big picture I want people to take away from
this is in five years, and I'msure if we had more data, we
would see it for decades, iswe're seeing a systematic
devaluation.
Behavioral health is oftengetting targeted to cost
contain.
So, like we're just doing costcontainment measures, even
though there's a demand, becausein most states, I think across

(11:18):
the nation, there is a mentalhealth crisis.

SPEAKER_00 (11:22):
You weren't lying when you said that question was
gonna This is a tough podcast.
Yeah.
Derek, even when cuts arereversed after these advocacy
efforts, what do you see as likea long-term impact that these
threats are having on providersand their clients?

SPEAKER_03 (11:42):
So even when the cuts are reversed, the very act
of the cuts is a shot at theindividual and the profession.
It's a it's a systematicdevaluation that impacts how we
think about ourselves and theprofession.
Think about how you wouldrespond to a client continually
being devalued by a partner.

(12:02):
We know the psychologicalimpacts.
But on the greater stage, thesechanges undermine the finances
of a business and can destroy asmall business, which is what we
all are.
You know, Mike actually justtalked about payments are
withheld and then it's reversed.
What would happen to youpersonally, to your personal

(12:25):
finances, if 40% of your incomewere withheld until next year?
Most people would default ontheir mortgages.
They they would they would losethey would lose ground, and that
that puts businesses under.
We'd like to think of ourselvesas counselors, but in the
marketplace, to the government,to the IRS, we're businesses.

(12:46):
And we have to act as such.
Even when reversed, these cutsthreaten to destabilize the
practices.
They they drive fear and theypush counselors out of the
field.
And I say that quite literally.
I have three longtime friendsthat I met as counselors, and
through counseling, who all haveleft our profession and now are

(13:06):
educators.
They're in software and realestate.
We often place ourselves and ourroles as helpers ahead of being
practice owners and smallbusiness people, which is often
argued as ethical, but inreality, it undermines the value
of our business and what we do.
Our inherent dignity cannot besacrificed in our efforts to

(13:29):
help other people.
So when we think about thingslike self-care, how much of our
efforts are directed towardsstress related to insurance and
finance?
Wouldn't it qualify as proactiveself-care if we were to start
taking care of our businesses ina way that they became less
stressful?

(13:50):
We are put in a situation by thefree market and the legal system
that force us to come togetherand to push back as business
people.
And we're simply looking forequitable treatment and
compensation.

SPEAKER_00 (14:07):
Yes, yes.
So, Derek, tell us more like howyou see this discrimination
playing into workforce shortagesand burnout.
Like you mentioned your friends,like how do you see this
impacting counselors in theprofession as a whole, like with
shortages and burnout?

SPEAKER_03 (14:25):
Well, you know, we could argue that the structural
discrimination impacts everylevel of what we do.
You know, it starts with workingour fingers to the bone to see
as many clients as possiblebecause when you're underpaid,
you rely on volume rather thanvalue in your contracts.
Then that work is being doneunder constant fear of clawbacks
and insurance audits, which feelimpossible because we work

(14:48):
within a system that hasever-changing expectations for
the documentation.
The notes are not specificenough.
Then when you get more specific,you're just giving them
ammunition to pull more thingsapart.
Pretty soon you spend aboutthree additional hours trying to
justify the original one hourthat they paid you.
And then this leads to the nextstage where the rates place us

(15:12):
at a disadvantage as we can'tafford the same legal assistance
that they have in-house.
Getting paid with premiums thatwe earn for them and they
withhold from us.
They have a department oflawyers to keep money in their
pockets and us broke, separate,and scrambling to keep our
acorns before winter sets in.

SPEAKER_02 (15:32):
Yeah.

SPEAKER_03 (15:32):
You know, money and legal influence has set a legal
premise that prevents us fromdiscussing reimbursement while
allowing insurers to discussthat same reimbursement.
Again, this creates a cycle inwhich we stay underpaid, we
can't afford representation, andthat cycle of lack of

(15:53):
representation was actuallyrecognized by the Iowa court
system, who acknowledged thatcounselors have no power to
negotiate with insurancecompanies.
This was said at the state courtlevel.
Yeah, I guess.
Please think about that for aminute.
We have courts acknowledging thedisparity, and we're still not

(16:15):
getting assistance.
And it's because we don't havelegal standing, we don't have
representation because thatcosts money that we don't have.

SPEAKER_00 (16:28):
Sounds like they it was built to do that, huh?
Yeah.

SPEAKER_01 (16:31):
Precisely.

SPEAKER_00 (16:33):
Ugh, yeah.
Mike, it's can you talk aboutlike the private practice side
of this too, especially thosewith maybe smaller practices who
are generally more disadvantagedthan some larger hospital
systems?

SPEAKER_04 (16:48):
Yeah, I mean, I can even speak to my own practice.
You know, I uh so my partner andI run a small private practice
in Canton, Ohio.
We're a two-person outfit and wehave some independent
contractors who are gettingtheir LPCCs, independent
license.
Derek's exactly right.
When you think about theselarger systems, legally created
systems, they have entiredepartments dedicated to billing

(17:11):
and negotiation.
I don't think there's a weekthat goes by that my partner and
I are maybe on the phone for 10hours a week, in addition to our
already seeing billable clienthours plus supervision.
And most of those 10 hours ofcalling insurance is to maybe
chase down payments or chasedown if there was a clawback or
to just call an insurancecompany for guidance, I'm mostly

(17:34):
spending that time on hold.
So when you start kind ofdigging into this, independent
counselors, we often, when youthink about negotiation of
contracts, you're just giventhis contract.
And we'll talk about how intensethese contracts are.
You're kind of told to take it,like this is what's good for
you, or you don't get to workwith our insurance panel.

(17:56):
They often have opaque ornon-negotiable rates, and many
times we won't even be able tofind the rate on the contract,
depending on the insurancecompany.
You have to almost ask for it.
It's a separate form.

SPEAKER_03 (18:07):
To accentuate what Mike just said, I'm gonna jump
in for a second.
To accentuate what Mike justsaid, I've gone back to
insurance companies to ask themto change terms in the
contracts, and they literallychuckled, saying, This isn't up
for negotiation.
So when he says you we we reallycan't, we literally can't.
Sorry, Mike, keep going.

SPEAKER_04 (18:30):
Well, and then I find like I will often myself
push back, as Derek said,because there are policies that
are often unfeasible for us as asmall, small private practice.
One common boilerplate, onethat's being kind of snuck into
a lot of insurance contracts, isthis 24-hour rule where you in
24 hours have to see a client ifthey are seeking mental health

(18:51):
care.
And now, if you think aboutthat, that's essentially how a
hospital system runs.
And so for us, we don't have thecapacity to be able to do that
24-7.
But yet then I'm in violation ofmy contract.
So if I sign something that putsme in violation, then there's
this whole issue about is thatyou can see how this just

(19:12):
becomes a cycle.

unknown (19:13):
Yeah.

SPEAKER_04 (19:14):
And that's the other thing.
Like if a reimbursement rategets cut, we're gonna feel it
immediately.
Because as a small business, Iagain, different percentages of
clients have differentinsurances.
I'm paneled with differentinsurance companies.
But if one of the larger ones,let's say, were to change how
they reimburse me, that couldpotentially make it very hard
for me to function as a smallbusiness, at least.

(19:36):
If not, if it's a major change,like with the change hack, if
everyone remembers the changehack that happened, I didn't get
paid for about five months.

SPEAKER_02 (19:46):
Wow.

SPEAKER_04 (19:47):
And so, you know, when you kind of start doing the
math on that, and I think therewas a class action lawsuit, many
counselors jumped on on that.
It's financially unsustainableif we even have one rate change
for many counselors out there.
And I know a lot of just smallindependent counselors that beat
paneling is makes or breaks thedifference.
And we'll talk more aboutactually paneling and why we

(20:10):
still choose to panel, because alot of counselors are choosing
not to.
I know a colleague of Derek'sand and someone I presented
with, Dr.
Lynn Jennings, wonderful womanwho published one of the leading
books on private practice.
She did an ACA focus group onprivate practice and identified
that a lot of private practicesacross the nation are failing.

(20:31):
And one of the major primaryreasons is because people are
struggling with being able tojust deal with insurance issues.

SPEAKER_00 (20:51):
Like that these are all really important things
that, you know, I belonging todifferent social media groups
and seeing differentconversations that counselors
have been having, or even justseeing stuff on TikTok or
wherever about clawbacks, likeit's it drives people to other
options, sometimes othercareers, but I'm just like

(21:13):
firing on all cylinders, havinga lot of thoughts as you both
share.
You mentioned Mike, like ratesbeing opaque and non-negotiable.
Derek, what do you feel like aresome of these biggest
accountability gaps because ofsome of these really vague
things happening?

SPEAKER_03 (21:33):
Uh it really begins with lack of training, lack of
transparency, and legalloopholes that not only allow
insurance companies to be vagueand not provide information, but
conveniently prevents them fromproviding direction to their
providers.
So, for example, most insurancebilling is learned on the job.

(21:55):
While we work in the sameoffices, counselors are trained
in parallel to provide services,not to bill for them.

SPEAKER_02 (22:01):
Yeah.

SPEAKER_03 (22:01):
So when claims are rejected, counselors will often
ask, I've done this.
We often ask insurance companiesfor direction and are told that
the insurance companies cannotprovide direction on billing.
So we are left in the dark.
Although they they can tell youwhat not to do, they can't tell
you what to do.

(22:23):
But anyone who's ever workedwith children knows that this is
a foundational and fundamentalproblem.
No creates frustration.
We we need to be directed inwhat to do.
However, the same insurancecompanies that cannot provide
direction often downcode orrecommend down coding, which is
providing the exact directionthey often deny when asked.

(22:45):
So this just shows that they canonly give direction when it
results in them saving money,not cutting a check.
They can't tell us how to getpaid, but they can tell us to
go, they can recommend to gofrom a 908.37 to a 908.34.
And I will challenge anyinsurance company out there to
show me documentation of a timethat they recommended someone

(23:07):
use a 908.37 and do a one-hoursession instead of a 45-minute
908.34 because it was consistentwith the evidence-based model
that they're reimbursing for.
I will challenge anybody, showme documentation of that.
It doesn't happen.
They're not looking for bestpractices, they're looking for

(23:27):
cost savings.

SPEAKER_04 (23:32):
Can I just jump in there too?
Because I want, I want to throw,let's just like think about what
you said there, Derek.
Because what's so challenging tome is counselors, right?
We are very ethical as a field.
We care about helping ourclients.
Like that's often when I talk tocounselors, they say the reason
I take insurance is because Icare about my clients.

(23:52):
And, you know, when I look at,we're trying to do the right
thing by asking how to do itcorrectly.
So then we can create an easierway for people to get help.
And we are being told, sorry, wecan't help you unless it
benefits us financially.

SPEAKER_00 (24:15):
Lots of thoughts, some words I can't say here.
But Mike, can you share somereal examples of how these
delays, denials, seeking priorauthorizations have like
disproportionately impactedsmaller practices?

SPEAKER_04 (24:31):
Yes.
So as the chair of the IACcommittee, I probably hear this
several times a week fromcounselors just reaching out to
me across Ohio who are runninginto kind of the same systemic
barriers that we're all talkingabout today.
I'm gonna try to define a few,but one of the things that I'll
make sure to provide at the endof this, and what we did as
counselors that we took to thehigher Ohio Behavioral Health

(24:53):
Provider in advocacy group, weall they're also seeing similar
things.
But what we did is we foundthere's at least 17 of these
major barriers that areimpacting all counseling
practices in some way, shape, orform.
The most common that we'reseeing right now that I can
think of direct examples ispaneling delays.

(25:16):
So, like counselors who aretrying to seek paneling, they're
trying to get a contract with aninsurance company.
We're seeing and hearing that itcan take months to almost a year
sometimes for some people to getcredentialed.
There's often littlecommunication in it.
And this is especially painfulconsidering Ohio, as I've
learned from our allied friendsin other states, we actually

(25:39):
have prompt pay laws.
And that's its own unique thing,which means two things.
First, we should have ourpayment typically within 30 days
of our submission, unless it'srejected for something that we
did poorly on the forum.
We may missed a box.
But even if you submit thecredit claim, it's typically 30
days.

(26:00):
Credentialing should be a 90-dayprocess.
That being said, I now hear thatthat law is being interpreted uh
pr very liberally by someinsurance companies that some
may assume it takes 90 days perstep of your paneling.

(26:21):
And I've even heard of somepeople being told the 90 days
doesn't start until they inviteyou to the insurance panel.
Now, I've been working in thisfield, I, you know, I'm probably
newer than maybe some othercounselors out there.
I don't know many counselors whohave ever been personally
invited to panel with aninsurance company.

SPEAKER_02 (26:42):
Oh man.

SPEAKER_04 (26:44):
The other one that I think just to kind of throw, and
like I said, I'll share thislist so everybody has it, but
clawbacks, which is retroactivedenials where insurance
companies demand repaymentmonths to even years.
It depends on the insurancecompany.
There's laws about that, thatwere already approved and
delivered.
So you as a counselor couldeight months after think

(27:08):
everything's good, and thenboom, they could be auditing and
clawing back several of yoursessions that maybe, if you're a
small business, have alreadyspent into other places of your
business.

SPEAKER_03 (27:22):
Actually, speaking to that, I had that happen about
a year ago.
An insurance company came afterme wanting to do clawbacks that
were five years old.
That is what that is outside ofthe realm.
They they wanted to negotiatebecause they knew it was going
to cost me$500 an hour for areasonable attorney to fight

(27:42):
them.
And they actually pointed out tome that it's cheaper to pay them
than to hire an attorney.
So it speaks to that legaldisparity again.
We don't have representation.

SPEAKER_00 (27:53):
Yikes, yeah.
Oh man.
Appreciate you sharing like yourown examples too, because I
think it it matters that we knowit's like happening to all of
us.
It's not just something youheard or saw on the internet.
It's like this is real.
One of the lesser discussedissues that you both had shared
with me were like antitrust lawsand how they prevent counselors

(28:15):
from collective bargaining.
Mike, can you explain a littlebit more in practical terms what
that means for the counselingprofession?

SPEAKER_04 (28:23):
Yes.
And this is really the boogeymanwhen it comes to how we talk and
how we deal with this problemaltogether.
And this is actually why, andI'm sure Derek, you might feel
this way, because again, he wasthe chair last year, I see, of
really banging our heads againstthe wall, trying to find a way
through this.
Because it feels like there's noway out many times.

(28:46):
As independent providers, we arelegally, and I want to make sure
this is clear for everybody, andI'm gonna explain why this is
important, we are legallyprohibited from joining together
and negotiating reimbursementrates as a group.
And if we tried to sit down atthe table with insurers and
demand fair pay collectively, itwould be considered price fixing

(29:08):
under federal antitrust law.
So even talking about, and thisis I want to make this clear,
talking about the dollars andcents, the exact reimbursement
rate you received in yourcontract with other providers
can cross the line into anantitrust violation.
Now that's important because Isee a lot of people online, and

(29:29):
I don't think they're allcounselors, but this doesn't
matter, all behavioral healthproviders on TikTok or social
media that are often venting,putting themselves at risk of
legal trouble because they'resaying how much they're getting
paid.
So we can't even talk about howwe're disparaged.

(29:49):
Meanwhile, and this is whatwe're trying to talk about a lot
today big hospital systems,larger agencies, larger
integrated networks cannegotiate.
As a block legally, they canlegally negotiate their
contracts in a legallystructured way because it
demonstrates shared governmentgovernance and integration.

(30:12):
And that's often why they walkaway with larger or higher
reimbursement rates than theaverage small counselor who's
running their business.
For small practices and soloproviders, that legal framework
will keep us continuouslyfragment, fragmented, and
powerless.
And often it forces us to acceptwhatever rate we have because we

(30:33):
can't afford the lawyers, asDerek is saying, to cover the
cost of this.

SPEAKER_03 (30:54):
Yeah.
So antitrust is just one tool ina toolbox of anti-competitive
practices.
As counselors, we can't discussour insurance reimbursements
with other practitioners orwe're violating the federal
antitrust laws.
There was a caveat createdseveral years ago forcing
insurance companies to publishthese rates.

(31:16):
But again, they found aworkaround.
They put them in a large packet.
And when I say packet, it's likethis huge data packet that's too
large for typical computers toopen to even open, let alone
work with.
So for counselors to get these,we have to contract with tech
companies to harvest them andextrap, you know, they pull the

(31:38):
data out, which literally coststhousands of dollars that we
don't have, just to see what thereimbursement rates look like
and to not be isolated.
I actually did buy some ofthose.
So I do have data.
And I can I can talk about whateverybody in the state is being,
I know exactly how mucheverybody in the state is being
reimbursed by certain insurancecompanies.

SPEAKER_02 (32:00):
Wow.

SPEAKER_03 (32:02):
But it continues from there.
So unless you've purchased thatdata, you can't talk about it.
So but as it continues fromthere, you know, it includes
association of health plans thathave legislative access and
financial power to create theinfluence.
So while the while the healthplans actually have these

(32:23):
collaborative groups, they havea seat at the very table.
They have influence onlegislation.
And we don't, we don't even haveanybody in the room.
They're at the table and wecan't get in the door.
So how can we actually becompetitive when we can never

(32:45):
enter the race?
That's why things have tochange.
We have to figure out a way toget ourselves to the starting
line.
Exactly.
There are ways to do it.

SPEAKER_00 (33:01):
Yeah, yeah.
You mentioned like some of thesethings passing, and then we know
that even in state legislators,there's bills that are passed
that are, you know, likeseemingly really great and
supportive, but insurers seem tofind ways to work around them.
Mike, can you tell us like anexample of maybe where some
legislation like this has fallenshort?

SPEAKER_04 (33:23):
Yes.
And I want to start actually byshouting out that there are
several provider-friendly bills.
I'll provide it for the end ofthe podcast of these common
provider-friendly bills rightnow that are in our state
legislature.
Everyone that passes makes ourlives easier as counselors.
So everyone, we want to get allthe advocacy out on every one of

(33:45):
these.
However, many counselors I talkto and other behavioral health
providers often describe,because here's the thing a law
passes that assumes there's anenforcement.
And so when I talk to manybehavioral health providers,
they will often reportdifficulties with the Ohio
Department of Insurance andMedicaid.

(34:06):
And when I meet with the highergroup as the counselor in the
allied fields, there's data thatshows that many providers either
don't know how to file a claimif an insurance company is
violating one of these laws, orthey're hesitant to do so
because there's fear of legal orpotential financial blowback.

SPEAKER_02 (34:23):
Yeah.

SPEAKER_04 (34:24):
Are you painting yourself as a target?
That's a real fear manycounselors have.
And so filing a this is a goodexample.
You file a claim with theDepartment of Med Medicaid, it
requires you to navigate theirwebsite.
And many providers feel itcreates a conflict of interest
and it's a whole barrier to justnavigate the website.
So while I appreciate Ohio, wehave a department of insurance.

(34:46):
I've learned not all states havethe kind of place, it's also not
really how do I want to sayparity oversight.
Let's just maybe use that as anexample.
It's another issue that maybe wecan talk about, is while it
exists, the Department ofInsurance at Ohio Moss, and even

(35:07):
the state publishes annualreports and tracks complaints,
they say there's no public finesor restitution that's listed
publicly.
So, you know, when you findthat, yeah, there's these parity
requirements and they'retechnically enforced, there's
little visibility ofaccountability.
I can't find something to pointto today.

SPEAKER_02 (35:28):
It's not transparent.
Yeah.

SPEAKER_04 (35:30):
This is where I want to shout out our good ally in
Kentucky, Nicole Sartini, thefounder of the Mental Health
Insurance and Reform Task Force.
That's a grassroot organizationthat started in Kentucky because
they're sick of how they'rebeing treated.
And they are doing a lot ofsimilar things we're doing to
try to fight for parity,legislation, litigation, and

(35:52):
education.
And I really appreciate the workthey're trying to do because in
a year they've already educatedover a thousand practitioners
and they have grouped in withIndiana, especially after that
most recent insurance debacle.
So what I find and why we wantto bring this to Ohio is there
are groups that are beginning topop up that are having the same

(36:13):
shared conversation that we aregoing to have today.

SPEAKER_00 (36:19):
Very important conversations.
And I know that you have someresources that will link that
also go with that reform groupthat we can share that
information as well.
Derek, what do you think aboutlike what's making structural
solutions like tradeassociations or clinically
integrated networks more durablethan just relying on some of

(36:40):
these legislation pieces alone?

SPEAKER_03 (36:45):
We're here today for this exact reason.
You know, this is a systemicproblem that we need to address
with a systemic solution on astate and a national level.
We need to begin to reimaginehow we're handling insurance
contracting and reimbursement.
If we've been unsuccessful asindividuals for years, why are

(37:07):
we not coming together as afield?
Individually, we don't have themoney to hire high-priced
lawyers to represent usindividually or with
legislation.
But if we come together, wereally can do some amazing
things.
I don't have a half milliondollars to make systemic change.
But if we really want to makechange and know that we can be

(37:30):
agents of change, I'll bet thatthere are a thousand counselors
and practices out there that arecurrently losing the battle on
their own that could cough up$500 each.
And all of a sudden, we're inthe fight with actual
representation.
We are players, and it justbuilds from there.
This is the power of creating aformal trade association.

(37:54):
It allows for members tocontribute, to work together
legally, and benefit theirpractices, which will eventually
have ripple effects throughoutthe entire field.
Think of how easy it would be tomake an argument in Iowa if only
you can afford someone to makethe argument.
This is a good time to revisit astatement from earlier which

(38:15):
ties into this.
You know, nobody is running tohelp counselors.
They expect us to pay for theirtime.
We don't have allied professionspushing for better treatment of
counselors or hospitals pushingfor increased reimbursement for
our profession.
We have to do what we preachevery day.
We continually push clients toadvocate for themselves.

(38:35):
We often talk about how we as aprofession need to advocate for
those who are disadvantaged.
When do we start advocating forourselves?
I published an article incounseling today demonstrating
that counselors make anywherefrom half to a third of what
other professions with similareducations make.
We rightly advocate forminorities, minoritized pot

(38:57):
communities that have paiddiscrepancies of 15 to 20
percent.
So why are we not advocating forourselves who are disadvantaged
by 50% or more?

unknown (39:07):
Yeah.

SPEAKER_03 (39:08):
We keep fighting for everybody else while we pay the
price.

SPEAKER_00 (39:14):
In many ways, we pay the price.
Yeah.
Yeah.
For those who maybe aren't sofamiliar with some of the
terminology, Mike, can youexplain what a trade association
in the counseling context is andhow that might change the game
for advocacy, as well as likebreak down clinically integrated
networks and why they might helpprovide counselors with more

(39:36):
lever leverage?

SPEAKER_04 (39:37):
Absolutely.
And I want to shout out anotherthing I'm hoping that we can
eventually link to this podcastwhen it's up, is I want to shout
out the Ohio CounselorsAssociation for Providers and
Private Practice, OACPP, andRyan put me in there, extra P.
They are actually working withone of our colleagues who we've
been working with, a lawyer, whois going to hopefully be

(39:58):
providing this exactconversation for counselors for
free, so they can begin to havethese one-hour meetings and talk
about like what is a tradeassociation and clinically
integrated networks, and again,how this is creating a systemic
oppression.
That's very important for us tocontinue to keep in our minds as

(40:19):
we talk about this.
But to answer your question kindof briefly, in kind of
counseling language, a tradeassociation acts much like a
chamber of commerce.
I know a lot of privatepractitioners go through
chambers because they get healthinsurance that way, which a
little perk of a tradeassociation, you can group up
and create, you can actually bidfor better health insurance.

(40:39):
But essentially what it does isit creates a unified voice,
provides legal support, andfosters a professional
solidarity in it.
So again, I use that example ofa trade association.
These trade are, I'm sorry, achamber of commerce, people know
what chambers of commerce are.
They kind of help the smallbusinesses in that community,
that county, or that city.
These organizations can operateas nonprofits, even 501c3s,

(41:03):
while still functioning as atrade association, advocating
for interests of counselors.
And by coming together under thestructure, individual counselors
gain a leverage that we oftendon't see alone, as we've been
talking about today.
Trade associations can alsolobby state legislators.
In fact, there are associationsfor insurance companies that are

(41:23):
doing this exact thing againstour provider-friendly bills.
Just something to think about.
And then, as well as it providesresources to help counselors
navigate these challenges.

(41:54):
And I'm starting to see thesepop up a lot in Ohio.
Often you'll see like MDs, sodoctors and maybe counselors
mixed together in something ofthat nature, who work together
to improve often patient care,efficiency, and outcomes.
CINs create this sharedgovernance and structure and
data framework.
So data and contracts are kindof shared amongst each other,

(42:16):
which allows them to bypassantitrust.
So it allows them actually tolawfully negotiate collectively
under that antitrust law.
This is something that we'resaying that we cannot do
independently.
So by reframing counselors fromfragmented small businesses to
an integrated care partner orintegrated care partnerships,

(42:41):
CINs give providers a seat atthe table for these value-based
contracts.
We get shared savings.
It allows performance-basedagreements, which means we would
see likely improved value in ourservices.
But again, right now, beingisolated, we operate in a place

(43:02):
where there isn't really theability to secure fair
reimbursement while maintainingthe access we give and the best
practice to our clients.

SPEAKER_00 (43:16):
So what steps would Ohio counselors need to take to
begin building toward a CIN or astronger association framework?
Derek, tell us.

SPEAKER_03 (43:29):
So counselors start by uniting with a common goal to
be heard and reimbursed for thevalue that you provide to tens,
you know, if not hundreds ofthousands of people every day
and millions of people everyyear.
When I say uniting, I meanformally join the organization,

(43:50):
put your name on the roster andhelp fund the efforts.
We literally need the names onthe roster to show our
legislators how many of theirconstituents are being
represented.
And we need the funding to makesure that we have
representatives at the table.
So when I say that, there are acouple, you know, we've got a
specific state representative.

(44:12):
Everybody in her office knows myname, and they all know how to
stonewall me.
She will not meet with me.
I've been banging on her doorfor a dozen years, but she views
me as one person and onebusiness owner, and I'm just a
thorn in her side.
But if I have a thousand smallbusinesses in Ohio with me, if I

(44:32):
have thousands of counselors,she's gonna listen because she
counts on those votes inNovember.
But right now, I'm just a painin her rear.
That's why we need literallypeople to get together.
And when we say we we need this,we don't need tens of thousands
of dollars from any one person.

(44:53):
We can rely on the power ofnumbers.
You know, a million dollars is alot of money, but it's only$500
each if we can get 2,000members.
I don't have a million dollars,but I I can probably swing$500.
And I'm not, I want to be cleartoo, I'm not offering like
memberships or anything for$500.
It's just an example of thepower of working as a

(45:16):
collective, you know, showingwhat's possible if we listen to
our hearts, but leave with ourheads.
So, you know, beyond membership,we we need leadership, we need
vision, and we need soliddirection, most of which we we
have very carefully cultivatedover the past few years, which
is how we ended up talking toyou today.

(45:38):
We also have connection to otherstates and regions and voices
that had been heard nationally.
If we can show them whatmovement looks like in Ohio, a
national movement is not farbehind.
And I've been told thatdirectly.
People just need to see thedirection.
They need to see us take thesteps forward, and they will be

(46:00):
with us.

SPEAKER_00 (46:02):
Yeah, someone has to start.
You know, it's like the wave.

SPEAKER_03 (46:05):
Exactly.
Exactly.

SPEAKER_00 (46:07):
Someone in this some section needs to start.
You know, a lot of thisconversation thus far has
focused about provider pay,which let's be very clear, is
incredibly important as youyou've hit home on that.
That like we need to make money.
Like, it's why are we sufferingbecause we're just like the

(46:28):
empathic team, you know, on thefield.
And what I think we need to alsolike highlight is that this
impacts our clients.
Derek, can you tell us a littlebit more about how underpayment
of counselors does have a directimpact on communities and mental
health equity?

SPEAKER_03 (46:48):
Yeah, you're right.
It's not just about providerpay, but pay has an impact on
nearly everything that we do.
There's that ripple effect.
So let's start on the businessside.
I have friends that are doctorsand dentists and even nurse
practitioners that are going toconferences for continuing
education in fun places likeVegas and Hawaii.

(47:11):
They're maintaining theireducation with hybrid vacations.
I also know counselors stressedabout having to spend$50 for
online CEU packages becausetheir license renewal is
pending.
This leads to decline incontinuing education and less
prepared clinicians, reallydefeating the whole purpose of

(47:31):
continuing education to beginwith.
And this ties to the personalfinance piece.
We know that people withfinancial struggles have high
stress.
It's tough enough trying to makeends meet.
But when you have to makedifficult decisions to do
everyday things, like can wepick up a pizza and put gas in
the car?
That's real for a lot ofcounselors.

(47:54):
I don't know any counselors thatexpect to be wealthy as a
counselor, but they shouldn'thave to have to figure out if
they can pay for a child's sportor if they can go to a concert
or two a year.
They should be able to affordreasonable vacations and a
reliable car.
These factors compound toburnout.

(48:15):
People leaving the field to doother things where they can work
less and make more.
Many love what they do ascounselors.
They just can't live under theconditions which are driven by
this reimbursement debacle.

SPEAKER_02 (48:32):
Yeah.

SPEAKER_03 (48:33):
And this circles it back to client care.
And we can speculate about theperformance of undertrained
clinicians or those strugglingwith burnout, but let's look at
some simple facts.
The Rural Health InformationHub, and I'll make sure you have
that link, they have a map andit shows the counties across the

(48:54):
entire U.S., in which everycounty in the U.S.
it shows where they stand,whether they have a severe
mental health shortage, somewhatof a mental health shortage, or
no mental health shortage.
And even knowing what to expect,it's still shocking to look at,
or at least disheartening to saythe least.

(49:16):
There are literally entirestates that don't have a single
county without a shortage.
Most states only have a countyor a few at most that are not
under a complete shortage.
And this is the reality of thesituation.
The entire country felt theeffects.
What I'm talking about rightnow, everybody felt during
COVID.

(49:36):
Think back, you know, we don'tlike to talk about COVID these
days, but think back five yearswhen people would try to reach
out for counseling and there wasa six-month wait list.
People were hoping to get in.
And hopefully COVID never thatdoesn't reemerge, but we will
have other situations in thefuture in which we have mental

(49:59):
health crises.
We have small ones all the time.
And right now.
Exactly.
They're constantly there.
So what that means though isthat families every day are
feeling the effects of theshortage.
When we talk about where thisspirals to, we have thousands of

(50:22):
families, if not millions offamilies today, right now, as
we're talking, that aresuffering due to the mental
health shortage.
And the irony is sometimes thatmental health shortage is
because they had a great realtorthat just sold him a house.
He was the coolest guy ever.
He used to be a counselor thatworked with me, but he got tired

(50:45):
of the grind and the work andyou know the terrible conditions
that are often created by thefinancial side of counseling.
So he went to be really happydoing something else.
And he's great because he's agood listener.
He he understood what theywanted.
And he made a he made an amazingrealtor.

(51:06):
But that was also a tremendousloss for our system.
And families every day arefeeling that loss, whether they
realize it or not.
So, you know, there are otherthings that need to be
addressed, you know, things likethe shift in care.
You know, I've heard statisticsas high as 90% in some areas, in

(51:26):
that 90% of counselors are nolonger accepting insurance and
are cash pay only.
Given that most people simplycan't afford cash pay, this
limits care to only those withmeans.
Once again, marginalizing thosethat are not financially
advantaged.
We also have to acknowledge thefact that we're inadvertently

(51:49):
letting insurance companies offthe hook.
They're still collectingpremiums.
It's part of the package.
Those people are just notgetting the services that
they're paying for.
Could you imagine a system inwhich you go through the
drive-thru of a fast foodrestaurant and they don't give
you the fries because they'reout, but they still charge you
for them.
I mean, that's literally what'shappening every day.

(52:11):
People are paying for servicesthat they can't get.
But insurance has aget-out-of-jail free card
because they can claim fullrosters and point to insurance
contracts that require offices,provide services within 24
hours, but nobody's holding themaccountable to make sure that
those offices can do it.

(52:33):
It's the counselors being heldaccountable.
You know, the old saying, stuffrolls downhill, and without
representation, we're at thebottom of that hill.
It's us and our clients that paythe price.
Did you know that the CEOs ofthe six major national insurers
earned a combined total ofnearly$123 million last year?

(52:54):
This is six individuals.
Six people.
United Healthcare's CEO AndrewWhitdy made nearly$24 million
himself.
Poor David over at Cygna, heonly made$21 million.
And Bruce at Humana scraped byat a measly$16 million.

(53:16):
How did they get it?
Well, we all know.
Not ethically.
I mean, I'd like to seecounselors, and this is me being
reasonable, but I think kind ofmodest.
I would like to see counselors,you know, like a midfield making
roughly$120,000 a year.

(53:37):
And I think that's pretty modestcompared to$24 million,
especially when we're the onesthat are actually saving lives
and changing lives.

SPEAKER_00 (53:46):
Mm-hmm.
Mm-hmm.

SPEAKER_04 (53:47):
Just imagine that.

SPEAKER_00 (53:51):
We're we're working on it, right?
That's that's what we're tryingto do here.
You know, I think it is soimportant to consider these
things and advocate.
And we know that the downsidesometimes is that the providers
get that burnout and say, youknow what, I I can't keep doing

(54:14):
this.
I can't keep advocating becauseI'm not sure I can wait the time
it takes to get to that$120,000.
So, Mike, what happens whenaccess to these providers leave
the field because they are like,I just can't afford to keep at
this anymore.

SPEAKER_04 (54:32):
So in private practice, I work closely with my
power partner and I want toshout her out.
Dr.
Katie Gamby won an awardactually in in my county because
really worked to successfullylaunch 14 new practices to
address the provider shortage inmy area.
And that doesn't include thedozens of consultees that we

(54:53):
work with, individual counselorsand other private practice
businesses across the state.
And many of them have seen somesuccess from the work that we've
done.
However, the most commoncomplaint we get and the most
common issue we get is realdifficulties with insurance.
The cuts to Medicaid is a realthing.

(55:14):
Challenges trying to panel withinsurers is a real thing.
I believe there is someone Iconsult with who still has not
contracted with an insurancecompany, and he started in
January.

SPEAKER_02 (55:25):
Wow.
Yeah.

SPEAKER_04 (55:27):
And then add in the inadequate reimbursement, as
Derek has been talking about.
When counselors are underpaid,our communities suffer.
They lose access and they losethe ability to actually have
quality care.
Burnout nutrition, as you say,that leads to shortages,
obviously, but it also leavesvulnerable populations without

(55:50):
the support they need.
I always look at, and I thinkDerek maybe kind of said it
last, but I take insurancebecause I see it as a social
justice issue.
Because I think of myself, if Ihave insurance that I pay these
huge premiums for, I would wantto use my insurance.

SPEAKER_02 (56:06):
Yeah.

SPEAKER_04 (56:07):
I'm not against people who do private pay, and
I'm glad when people can getpaid their worth.
I want counselors to have theirdignity.
I also want my communities tofeel like they have a place to
go.
So ensuring fair compensationand reducing these
administrative barriers, it'snot just good for providers, but
it's essentially keeping careaccessible.

(56:29):
So you're not having long waitlists and counselors walking
away, all providers reallywalking away from using
insurance, which creates ghostnetworks, a giant list that an
insurance can provide you ofplaces you can go.
And none of them either exist orthey can't take anybody for over
a year.

SPEAKER_00 (56:59):
Not one of the questions that we discussed
ahead of time.
So you can say, Marissa, we needmore time.
But how do you feel or believelike the counseling compact may
contribute to some of thesechallenges?
Or I mean support them.
I guess like either way.
I guess I'm just curious how youfeel like the counseling compact

(57:19):
may play a role in some of whatwe've discussed today.

SPEAKER_03 (57:25):
Mike, I see you're muted, so I'll jump in.
I I have a lot of concerns aboutthe counseling compact.
I think in spirit it'sfantastic.
And it's the direction we wantto go.
The problem I see is that we aretrying to push it through so
quickly to get more people in,and that we're not working to

(57:48):
keep our standards high.
And that's exactly that createsexactly the types of cracks in
the infrastructure thatinsurance companies that's what
they wait for.
They count on those because whenwe suddenly have different
standards, we suddenly havedifferent groups, that gives

(58:10):
them room to move in.
And one of the other things wesee is that if you know they
don't have to negotiate with uswhen we're fighting with each
other.
So we need to unify.
We don't need to just agree tothe lowest standards so we can
get everybody to the tablebecause everybody's going to
fight at the table.
We need to increase ourstandards.

(58:31):
We need to go in with a unifiedagreement that this is who we
are as counselors.
We have value, we are a validprofession, and we deserve to be
at the table.
So I love the idea of thecompact.
I have significant concerns withhow quickly it's been pushed
through.

(58:52):
And I say that I compare it tothe Social Work Compact.
They are half as far as we are,and they've been working on it
exponentially longer.
And I think we need to look atthat and realize that faster
isn't always better.
You know, there's there's an oldbusiness saying you can have it
fast, you can have it cheap, oryou can have good quality, but

(59:13):
you only get to pick two.
So if we have it fast, are wegoing to sacrifice quality?
Or are we going to sacrificevalue?
And I'll tell you, I don't seethem pulling major dollars to
the table.
So if we're going to keep itcheap and do it fast, that says

(59:36):
the quality is not going to bethere.
And that's my concern.
I mean, I'm not, I'm not on theinside of that, and I'm not
throwing this out as shadetowards anybody doing it,
because I think they're they'rereally doing the best they can
to try to push it through.
I also think sometimes it's goodto slow it down and make sure
that we're still we still havethe same target that we started
out with.

SPEAKER_04 (59:57):
I want to echo a little bit of what Derek is.
Is saying here because I Iappreciate the compact.
I believe portability is a realissue.
And in terms of our conversationtoday, more counselors does not
mean integrated counselors.

SPEAKER_00 (01:00:10):
Right.

SPEAKER_04 (01:00:11):
And so my hope would be, I guess this is where I want
to reimagine even the use of thecompact is could this be a way
ACA could double down on thisconversation?

SPEAKER_02 (01:00:21):
Yeah.

SPEAKER_04 (01:00:21):
I get concerned when I see, and I'm sure OCA members
recently saw the survey come outthat they are trying to maybe do
away with the independentlicensing exam.

SPEAKER_02 (01:00:31):
Yeah, I did.

SPEAKER_04 (01:00:32):
And so some difficulty I have is in terms of
competency, will you see achange in how we do things?
And to Derek's credit, I seeinsurance, at least weekly, if
not daily, look for loopholes toundercut us because the goal is
to save money.
Remember, not to tell you how tobill.

(01:00:54):
So I'm get I get concerned aboutthese things.
And I would encourage ACA andOCA to maybe create a task force
or to do something aroundinsurance reimbursement so we
don't lose, as Derek's saying,the quality.
We've been talking to many legalservices over the past year, and

(01:01:16):
integrated networks have beenaround for decades.
So this is a conversation thatis not new for people.
However, I would say manycounselors had no idea this
exists.

SPEAKER_00 (01:01:27):
Yeah, yeah.
I appreciate you both beingcandid about it.
Like I know that this was not arehearsed or written question,
but I think it's important toconsider sort of one one other
thing to think about too is theway the current compact is
written.

SPEAKER_03 (01:01:42):
We are talking about counselor advocacy.
A lot of the states that thatwhere we're changing the
standards, people that arelicensed as counselors are only
licensed is licensed ascounselors.
They don't have degrees ascounselors and they don't share
the counselor identity.
So for example, if anotherprofession, if you've got a

(01:02:03):
number of people licensed ascounselors so that they can work
at the master's level while theyare, I mean, I'll just say it,
while they're working towards adoctorate in psychology, how how
invested are they in counselorrights?
Or is this a transitional piece?

SPEAKER_00 (01:02:21):
Right, right.

SPEAKER_03 (01:02:22):
You know, so we really have to think about who
we are bringing into the cluband are they going to fight for
what we're trying to do, or arethey going to add to the
segmentation that that insurancecounts on to keep us divided?

SPEAKER_00 (01:02:37):
It creates opportunities for more
connection and like moreconversations, but paradoxically
can create opportunity todisconnect or or
compartmentalize.
Yeah, yeah.

SPEAKER_01 (01:02:52):
Absolutely.

SPEAKER_00 (01:02:54):
So again, I appreciate you being candid.
I I, you know, I think there's alot of excitement around the
counseling compact.
And, you know, to to your point,portability is important, but
how does it maybe affect thisconversation that we're having?
I think is is equally important.
So, Mike, you know, kind ofcoming toward towards the end of
this conversation, if we had tospeak to some policymakers who

(01:03:18):
might be listening to thisconversation, what would you say
is like one action they couldtake today to enforce parity and
accountability?

SPEAKER_04 (01:03:27):
I would just start with exactly what you said is if
you want counselors to continuedelivering life-saving care,
enforce parity now.
Like enforce parity now.
This is not about convenience.
It impacts more than rough,roughly 50,000, if I believe I
pulled the numbers correctly,licensed providers under the

(01:03:47):
Counselor Social Worker MarriageFamily Therapy Board and
countless clients that theyserve.
The public already knows thatthe mental health system is
broken.

SPEAKER_02 (01:03:57):
Yeah.

SPEAKER_04 (01:03:58):
You have the power to reimagine it.
That's the key today.
Is do you want people, thepeople who are saving the lives
today, to still be heretomorrow?
Like Derek said, it would breakmy heart that the person who
sells you the house could havebeen the one who could have been
there for your family member inneed.

(01:04:19):
Do you let me just kind of sayenforcing parity and
accountability is how you becomechampions of this change instead
of just defenders of often astatus quo.

SPEAKER_00 (01:04:35):
Definitely.
For counselors in Ohio, Derek,like what are the most immediate
ways to get involved in advocacythrough OCA or or the committee
that you both have chaired orare chairing?

unknown (01:04:50):
Yeah.

SPEAKER_00 (01:04:51):
What would you say?

SPEAKER_03 (01:04:52):
For counselors, we we have to embrace the fact that
we cannot fight legalizedsystemic oppression alone.
That's been demonstrated.
The immediate step is to unitethrough OCA, through the
Insurance Advocacy Committee,and by building a trade
association or a clinicallyintegrated network that gives us

(01:05:14):
that leverage.
Our power lies in solidarity,not as fragmented small
businesses, but as a unifiedprofession reclaiming our voice,
our reimbursement, and again,going back to our inherent
dignity.
And I would actually expandthat, you know, to the general

(01:05:37):
public, you know, for clients,for families, for community
members.
Here's the truth.
The only reason we work withinsurance, and I say this, you
know, for myself, owningmultiple practices, not only in
Ohio but in other states, butalso knowing a lot of practice
owners.
The only reason we takeinsurance is because we want the

(01:06:01):
public to have equitable accessto care.
I cannot tell you how manypeople have offered me twice
what an insurance will pay me tobe out of network.
And it's really hard not to gothat direction.
But the minute I do, I know the14-year-old kid struggling with
suicidal ideation who relies oninsurance will not get the same

(01:06:22):
level of care.
Counselors accept lowreimbursement and crushing
administrative burdens so thatso that the public's loved ones
can heal.
But the weight of this legalizedoppression pushes so many people
out of the field.
When counselors are underpaid,clients lose access.

(01:06:43):
Dignity for counselors isdignity for clients.
And and your support is going tobe key to building a system that
honors meaningful labor andensures timely, affordable
mental health care for all.

SPEAKER_00 (01:07:02):
Another sermon.
It's powerful.
Mike, for the people we serve,like their families, community

(01:07:23):
members, what's the messageyou'd want them to understand
about why equitable treatmentfor counselors is a meaningful
cause?

SPEAKER_04 (01:07:33):
Yes, I guess let me answer that and then maybe add
in a little bit to what we cando as OCA folks.
Sure.
To answer your first thequestion, counselors today, we
talk a lot about social justice,but I want people to understand
that we are under legalizedsystemic oppression.
And we have to look at this as asystemic issue, almost like

(01:07:55):
going like to a couple's ormarriage and family therapy.
It's a systemic issue and asystem that strips away our
reimbursement.
Clearly, we have five years ofdata to back that up.
Our leverage and too often ourinherent dignity.
But this does not have to be ourfuture.
I want counselors who arelistening to this to begin to

(01:08:17):
reimagine behavioral health carein a way that honors the dignity
of both counselors and clients,where meaningful labor is valued
and sustained.
The evolution of our professionpoints us towards a collective
strength.
It's not just to fight back, butto fundamentally transform the

(01:08:37):
system.
This is about building realadvocacy, not just symbolic
gestures, not just a letter froma governor or something.
It's about creating a healthcarelandscape that everyone who
knows it's broken now, somethingthat they could believe in again
and trust.
Just imagine that.

(01:08:59):
My comment to counselors who arelistening to this, I want to put
forth future things.
Come to our insurance advocacymeetings.
We're having these conversationsmonthly.
Please come.
We need as many providers aspossible because we are doing a
lot in a very short period oftime.
In terms of the OACPP, which isfor private practitioners, they

(01:09:22):
are trying, I believe they'regoing to try to make it free and
they're going to try to have anethics CEU two at two different
times to help people's schedulesbecause again, we're
overburdened.
One, I believe they're trying todo in November, and one in
February, where they're going tobring in ethics of counselors
and then bring in a legal expertto talk about clinically
integrated networks and what atrade association is and why

(01:09:43):
this is legal systemicoppression.
And I also want to encourage OCAand ACA to begin to look at this
conversation as one of thebiggest things.
Every counselor you talk to saysthey are low reimbursed.
And what I think is difficult isno one understands how it's

(01:10:04):
legal systemic oppression.

SPEAKER_00 (01:10:06):
Yeah.

unknown (01:10:07):
Yeah.

SPEAKER_00 (01:10:08):
Any final thoughts, Derek?

SPEAKER_03 (01:10:10):
Yeah, I would just say join us.
Join us.
When I first got involved inthis committee, we we had a
steady group of three.
And and now we now we literallyhave about 20 people coming in
or out.
You know, we we had some somemajor shifts in the last year or

(01:10:31):
two.
And what I would you know, whatI want to say is join us.
You can actually see changehappening every month.
And and the more people, thequicker and the bigger the
change it's gonna be.
So come join us because thingsreally are happening.
It's not just talk, things arehappening.
And and the more people thatjoin us, the the bigger the

(01:10:53):
party, and the quicker, thequicker we're gonna get where we
want to go.

SPEAKER_00 (01:10:58):
And if you're listening right now and you're
thinking, maybe I should getinvolved, I want you to know
like our show notes are going tohave several links and a lot of
information that will help youaccess that and and be able to
get involved.
And it's not just us trying tomarket the podcast, but this is
such a meaningful conversationthat if you feel like this is

(01:11:19):
gonna resonate with colleagues,friends, anyone who's in the
profession or adjacent to it,even share this episode so that
they can learn and then have theresources to get involved as
well.
Mike and Derek, thank you somuch for joining Ohio Counseling
Conversations today.
Like I think I've said a milliontimes, but I can't say it

(01:11:41):
enough.
This is meaningful and soimportant that that we're here
having this conversation andsharing it with a large you
know, larger listenership.
And and I hope that we can keepit growing and and that we get a
lot of people joining thiseffort as a result.
Thank you again.
And um, you know, come back.

(01:12:04):
If there are more conversationsto have, you guys are always
welcome back.

SPEAKER_03 (01:12:08):
Thanks so much.
Thank you.

SPEAKER_00 (01:12:13):
As we've heard today, the fight for fair
reimbursement is about so muchmore than numbers on a fee
schedule.
When counselors are undervalued,clients lose access.
When reimbursement structuresare arbitrary and opaque, our
workforce burns out andcommunities pay the price.
Our guest reminded us thatlegislation alone won't solve
this problem.
We need structural advocacy,trade associations, clinically

(01:12:36):
integrated networks, and aunified voice that reclaims our
leverage in the system.
So here's our call to action.
For policymakers, enforce parityand hold insurers accountable.
For counselors, unite throughOCA and the Insurance Advocacy
Committee.
For the public, understand thatequitable treatment of
counselors is essential toprotecting access to mental

(01:12:58):
health care for your familiesand communities.
Thank you to our guests forsharing their insight and
passion, and thank you forlistening.
To stay connected with thiswork, visit ohiocounseling.org
and check out the InsuranceAdvocacy Committee page.
Until next time, keepadvocating, keep connecting, and
keep the conversation going.

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Conversation 35 - Reclaiming Counselor Dignity: Insurance, Antitrust, and the Path to Equity

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Conversation 35 - Reclaiming Counselor Dignity: Insurance, Antitrust, and the Path to Equity