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Aetna is cutting reimbursement rates for therapists credentialed through Alma effective July 15, 2026. If you are a solo therapist, psychologist, LCSW, LPC, or LMFT using Alma to bill Aetna, here is exactly what is changing, how much money you could lose based on your credential level, and what to do before the deadline. Updated June 14, 2026 - 31 days until the rate change takes effect. Alma providers are now in the final window before Aetna's July 15 reimbursement changes g

By Danielle Wagar, CPES | Upstate Healthcare Admin You typed it into Google at 11pm after a particularly frustrating day. "Can I leave Headway?" Maybe your reimbursement rates feel insulting for the level of care you provide. Maybe you are tired of being locked out of your own billing data. Maybe a client mentioned they found you through the directory and you realized, with a sinking feeling, that you have been building someone else's referral network for free. Whatever broug

There is an exciting point in a therapy practice owner's career when the waitlist grows too long, demand outpaces your schedule, and you realize it is time to expand. You decide to transition from a solo setup to a group practice model by hiring your first associate or licensed clinician. Many practice owners assume that because they are already in-network with insurance panels, bringing a new therapist on board simply means handing them a client roster and billing under the

You submit a batch of claims through your clearinghouse, check your dashboard a week later, and notice a handful are marked as pending. Another week passes, then a month, and nothing moves. The money sits in administrative limbo while your practice overhead keeps running. For solo and small group mental health, physical therapy, occupational therapy, and speech-language pathology practices, watching revenue freeze behind an insurance wall is one of the more demoralizing parts

By Danielle Wagar, CPES | Upstate Healthcare Admin Here is a scenario that plays out in mental health practices regularly: a provider completes Medicare enrollment, receives their PTAN, and starts seeing Medicare patients. A few months in, they notice some Medicare patients have cards that say Humana, UnitedHealthcare, or Aetna. Claims are submitting to the wrong payer. Prior authorization requirements keep appearing unexpectedly. The answer is that Medicare is not one thing.

By Danielle Wagar, CPES | Upstate Healthcare Admin Medicare enrollment is one of the most misunderstood processes in mental health private practice. Providers avoid it because it feels complicated. They delay it because they do not know where to start. And then they refer out every Medicare client for years — clients who could have been seen in their practice. This guide breaks down exactly how Medicare enrollment works for mental health providers. Who This Applies To Medicar

SimplePractice's free credentialing gets your applications submitted, but it will not build the billing system that gets you paid. Here is what is actually missing, and what to do about it.

By Danielle Wagar, CPES | Upstate Healthcare Admin Blue Cross Blue Shield is not a single insurance company. This is the thing most providers do not fully understand when they get credentialed with their local BCBS plan - and it is why BCBS claims can behave so differently depending on the patient in front of you. BCBS is a federation of 33 independent, locally operated member plans. When your patient has a BCBS plan from another state, the BlueCard Program governs how their

By Danielle Wagar, CPES | Upstate Healthcare Admin If you bill for telehealth sessions, you have almost certainly encountered modifier 95 and modifier GT. You may have used them interchangeably. You may have used the wrong one without knowing it and had no idea why claims denied. This guide clarifies exactly when each modifier applies and why using the wrong one will get your claims denied. What Telehealth Modifiers Do Telehealth modifiers are codes appended to a CPT procedur

By Danielle Wagar, CPES | Upstate Healthcare Admin You signed a lease. You bought the furniture. You scheduled your first client at the new location. And then it hits you: none of your insurance panels actually know this address exists yet. Adding a new office location to your existing insurance contracts is one of those tasks that looks simple on the surface and turns into a 90-day project if you are not prepared. Claims get denied. Patients get billed incorrectly. Payers as

If you deliver telehealth to Medicare patients across multiple states, you do not need a separate PECOS enrollment for every state. Here is what the rules actually say -- and the one compliance piece most providers overlook.

New York Medicaid now pays $136.91–$153.07 for a 60-minute therapy session depending on your license. Here is exactly what LCSWs, LMHCs, LMFTs, and psychologists earn under the current eMedNY fee schedules, compared to BCBS, UnitedHealthcare, and Aetna.

Let's skip the "follow your passion" intro and get to the numbers. Starting a therapy private practice is absolutely doable. But most first-year practices run into the same financial problems: costs that were higher than expected, revenue that arrived later than planned, and a few surprises nobody warned them about. This post breaks it all down. What you will actually spend, what tends to blindside people, and how the math changes depending on whether you are starting fresh o

If you are a solo therapist, LCSW, LPC, LMFT, or PMHNP billing telehealth sessions through insurance, there are two modifiers that live at the center of your claims workflow: Modifier 95 and Modifier 93. Getting them confused, or leaving them off entirely, is one of the most consistent sources of telehealth claim denials in mental health billing right now. The distinction between them is not complicated once you understand what each one is actually communicating to the payer,

If you're thinking about leaving Alma, Headway, Grow Therapy, or Rula, the real question isn't credentialing. It's referrals. Here's how independent therapists build a referral pipeline they own and protect their caseload for good.

Starting a private practice brings a wave of excitement, but it also uncovers a complex administrative sequence that leaves many clinicians feeling completely overwhelmed. When you are moving from an agency position, a hospital role, or a managed care platform into your own solo or small group practice, the sheer volume of acronyms can cause immediate paralysis. You know you need a business structure, an identification number, a credentialing profile, and insurance contracts,

Nobody tells you this when you start your practice. You spend weeks preparing to go in-network. You research the payers you want to work with. You pull together your licenses, your malpractice coverage, your NPI information. You submit the applications and feel, for a moment, like you have checked a major item off the list. Then you wait. And keep waiting. And at some point, usually around week eight, you start to wonder if something went wrong. What Is Actually Happening Dur

When you are setting up a private practice, administrative tasks can quickly become overwhelming. The healthcare industry loves acronyms, and two of the biggest gatekeepers to your revenue are PECOS and CAQH. For many solo and small group mental health, physical therapy, and speech therapy practice owners, these two systems look almost identical from the outside. Both demand your personal information, your license numbers, your practice locations, and your tax details. The co

You did everything right. The session was documented. The claim was submitted on time. The CPT code was correct. And then it came back denied. If you have been billing telehealth sessions and running into denials, underpayments, or payer audits you cannot explain, there is a good chance the problem is not your diagnosis code or your documentation. It is two digits on your claim form that most therapists never think twice about: the place of service code. Specifically, the dif

If you are starting a therapy practice, hiring clinicians, or trying to figure out whether insurance is even worth it anymore, this is the question underneath all the others: "What do these sessions actually reimburse?" Nobody opens a private practice dreaming about payer fee schedules and contractual adjustments. But eventually, everyone ends up here. And the reimbursement numbers floating around online are usually outdated, overly vague, or pulled from a Facebook group comm