Anthem Dropping Rates by $47 per session? What this means for Therapists
Updated July 30, 2025
Buckle up…there is a lot happening. But, let’s start with the headline. Mental health providers in Indiana contracted with Elevance AKA Anthem received an email around 4:53 pm on a Friday stating that any sessions for CPT code 90837 would be reimbursed by somewhere between $47-50 LESS.
We want to unpack what to do if/when insurance companies change your contract or lower your reimbursement rates. We want to give you the skills to manage this no matter what state you are working in. And, we want to talk about how to protect yourself regardless of your current setup as a mental health provider.
First, we think some details about a particular insurer are always relevant as you explore how YOU want to respond to a change in contract or reimbursement. We want to think about the changes in the context of the particular insurer and situation.
Elevance Health, Inc. formerly Anthem
Elevance/Anthem and their history can be super important in understanding how we got here as you determine what your next steps might be. In 2022, Anthem rebranded as Elevance to focus on “whole health” services and go beyond medical insurance. There focus is on being the health partner for anyone who is enrolled.
Elevance Health, Inc. is a for-profit company traded on the New York Stock Exchange under ELV. When a mental health company like Elevance Health (traded as ELV) is publicly traded, it means the company is owned by shareholders who buy and sell stock on the open market. This ownership structure directly influences how the company operates, including its responsibilities and priorities. Here's a breakdown of the duties Elevance has to its different stakeholders:
1. Duty to Shareholders (Primary Legal Obligation)
As a publicly traded company, Elevance's primary and legally binding responsibility is to its shareholders—the people and institutions that own its stock.
This is a fiduciary duty, which means the company must act in the best financial interest of shareholders.
In practice, this often translates to maximizing profit and increasing stock value.
Executive decisions, including cost-cutting, automation, restructuring, or outsourcing, are typically aimed at improving profitability.
What this means: The company may prioritize efficiency and shareholder returns over service quality, employee satisfaction, or provider compensation.
2. Duty to Customers (Members, Clients, Patients)
Customers include insurance plan members, employers, or state contracts (such as Medicaid plans). Elevance must meet regulatory standards and provide a minimum level of care.
These duties are governed by external regulations, not by fiduciary responsibility.
Elevance must ensure access to care, maintain a provider network, and comply with healthcare laws.
However, customer satisfaction is still balanced against profitability.
What this means: While patients must receive some level of care, limitations on sessions, delayed authorizations, or denied claims are tools the company may use to reduce costs.
3. Duty to Providers (Including 1099 Mental Health Clinicians)
Therapists working as 1099 contractors are not employees and are not considered internal stakeholders in the company.
The relationship is governed strictly by contract law.
Elevance is obligated to honor contract terms and issue payment accordingly.
However, the company has no fiduciary duty or broader ethical responsibility to ensure fair pay, job satisfaction, or support for contractors unless legally required.
What this means: As a 1099 provider, you are part of the supply chain, not a stakeholder. Your compensation and workload are managed based on what benefits the company's bottom line.
Rideshare App Analogy
Elevance operates like a rideshare platform AKA Lyft, or Uber.
Shareholders expect more riders, more routes, and more revenue without increasing costs.
Customers want quick, cheap rides.
Drivers (therapists) are independent contractors using their own time and tools. If costs go up or performance drops, the platform just recruits more drivers.
Takeaway: You're not a partner. You're a cost that the company is constantly trying to manage or minimize.
How are the Profits Going for Elevance Health, Inc. ELV?
Here are the profits for the last 5 years for Elevance, formerly Anthem. Remember, profits are income AFTER accounting for all expenses. Those expenses include payroll for customer service, bonuses, provider reimbursements, etc.
2025 profit to date $5.9 Billion Dollars
2024 profit $6.2 Billion Dollars
2023 profit $6.1 Billion Dollars
2022 profit $6.3 Billion Dollars
2021 profit $4.7 Billion Dollars
2020 profit $4.8 Billion Dollars
Remember, Elevance is a for-profit company providing medical and behavioral health services. They provide medical insurance directly for employer provided healthplans, healthplaces in the marketplace, and also have contracts to provide behavioral health services through state contracts. In fact, they said they are placing a “strong focus” on behavioral health and had 740 million dollars in new contracts with California and Maryland alone at the state of 2024.
Carelon formerly Beacons and Value Options
So, let’s talk more about the behavioral arm of Elevance Health named Carelon. Carelone is a merging of Beacons and Value Options. What does Carelon say that they do? “We are constantly innovating, developing solutions that connect providers to evidence-based clinical insights to guide personalized care decisions. Solutions that help payers manage risk and deliver exceptional whole-health care to their members. And solutions that provide individuals with simple, seamless, and affordable healthcare.”
Carelon is taking this message out to individual states to sell the services and attempt to take over being a provider for severe mental illness and behavioral health at the public school level, and within the Child and Youth Services arms around the country.
But, what are the experiences of therapists working with Carelon AKA Beacons, AKA Value Options?
If you’ve been around for any length of time you probably know these names. In New York, Beacon, formerly Value Options were given a $900,000 penalty for wrongly denying New Yorkers mental health and addiction care. There are current lawsuits for ghost networks- showing potential patients that they have more providers than they actually do.
“Carelon has one of the lowest BBB ratings and is awful to deal with. They agreed to pay then said no then refused however told the client and myself that they were going to pay then stopped answering call. Eventually we had to get the clients company involved to go to bat for her against Carelon to get them to pay. I cannot believe anthem is doing this with a company with so many grievances against them”
“Carelon is awful. I'm organizing a collective effort to highlight their abusive practices.”
“I didn’t realize Carelon was Beacon. It all makes sense now.”
“Ask for the official complaint department for Carelon and file a formal complaint. Our case was presented at the head people in our state and nothing really happened until we started filing complaints with the state insurance commissioner”
They are actively using mental health services and labor to sell new contracts and expand their behavioral health services nationwide.
Ok- so let’s get back to Indiana therapists and the new contracts
Here is the post that popped up on Miranda’s facebook feed on Friday June 27th from Jessica, a group practice owner and therapist in Fort Wayne, IN:
“The email explains we have a new contract effective 9/1/2025 stating if we choose to stay in-network Master's level clinicians take a $50 - yes 5-0 dollar an hour pay cut for counseling sessions. We have 30 days to decline by sending a certified letter.”
According to Jessica they had received a letter after Elevance/Anthem combined with Carelon, etc. “In February (of 2025) we received a certified letter notifying us that Anthem and Carelon were becoming one organization and all mental health claims for Anthem would be processed through Carelon, but our reimbursement rates wouldn't change. It stated we would receive an updated contract to incorporate Carelon next month.”
Instead, of a new updated contract, now in June of 2025, a few minutes before closing, this clinician received this email with the new contract. The phones were impossible to get through on. The email included to contact with any questions bounced back as not functioning.
But Jessica isn’t the only therapist in Indiana who is struggling:
“I am so over this whole transition----I haven't been paid in 4 months since the switch. I also remind myself of this fact each week, so I can keep fighting.”
“Call Carelon and ask if you are in network! They said I am in for credentialing but I never gave them any information nor signatures. I am truly worried about clawbacks! I did not request to credential with them! 800-397-1630. Option 4 then option 3 to check your in network status.
Edit.... I just called and asked if I was listed as in network forvtheir Carelon clients. The operator said yes and that I had been since earlier this year. They were willing to give clients my name as an in network Carelon provider. I shared with the operator that was wrong. This is not an accidental error. Paneling with Anthem Blue Cross Indiana is no longer an option through availty. Now there is a Carelon link. My declining letter will be in by the end of the week. They should not be able to put my name on their panel when I did not sign their contract.”
“Carelon is the bane of my existence. We have to get pre-cert with them. We can request 8 visits, they might give us 4. I've had several peer-to-peer reviews, wasting hours of my life, for them to still deny. It's so frustrating.”
Reading over conversations with Indiana Therapists- they are spending hours emaling back and forth with Carelon/Anthem and trying to navigate and make sense of this change. They are documentation everything and finding they often get completely different information about what the contracts means and what the issues are.
Some therapists received no email and were told it was because they were opted out- even though they get emails from Anthem and Carelon regularly. Others are being told that the new fee schedule is something that is unrelated to their old Anthem fee schedule and their fee schedule won’t change, while others are being told the opposite and they have to opt out by September 1st or the new fee schedule takes effect. Some therapists are talking to attorneys to determine if they can file a joint suit, while others are concerned because of the arbitration agreements buried in every contract.
In short, it is a mess. It is stressful. And it is taking therapists’ energy away from where they want to focus- on client care.
Here is an update regarding the requirement to be with Carelon to take Anthem clients according to an Indiana therapist:
“we have to be credentialed with Carelon to accept Anthem clients, per Alisa. I will be checking with the attorney, but here is her response: To stay in network with Anthem plans, you have to accept the contract on Carelon paper. Carelon is managing the credentialing and contracting for Anthem.
The part you can opt out of is being in network for the Carelon member plans,:
Is that clear as mud? Absolutely!
But is it impacting other states?
“I would like to connect with you on this, as Carelon is egregious in my state, too. We don’t have Anthem locally (unless they bought out Carelon nationally - it is such a shell game to understand and I truly can’t grasp it), but they also have a horrible rep for non-payment here via us billing through BCBS/Highmark to Anthem.
“My insurance-based business has been devastated by a combination of Carelon and Highmark; and as a person who formerly had insurance under Carelon, my health was devastated as well. I want to take action. I know other therapists willing and wanting to join action against the (alleged) malfeasance.”
“I wonder if that’s nationwide. I haven’t received any correspondence at all about all that. I did put in a termination letter to Carelon recently because apparently the one I sent to Beacon got lost in the transition. I still have Anthem clients and the reimbursement rate hasn’t changed.”
“We just spent 6 months wating for our contract with carelon bcbs in nevada. We got offered abysmal rates that we had to turn down the contract. I hate that they won't tell you their rates at the beginning of the process but refuse to negotiate. Like you said as a group practice owner I can't pay my staff a reasonable wage on those reimbursements. But its so sad because the demand for in network providers is so high”
“Call Carelon and ask if you are in network! They said I am in for credentialing but I never gave them any information nor signatures. I am truly worried about clawbacks! I did not request to credential with them! 800-397-1630. Option 4 then option 3 to check your in network status.”
What are therapists’ options in 2025 with insurance companies?
Why can’t therapists create a union?
Ok, it isn’t technically true that therapists can’t create a union. The truth is, therapists who are employees can create unions. Those unions can negotiate with their employees to set minimum pay requirements. Those employers can then negotiate with insurance companies for reimbursement rates based on the cost of employee wages (among other things).
But, here’s the thing you amazing private practice therapist- you are NOT an employee. We know you hear therapists say things like “I’m paid as a contract employee.” “I’m paid as a 1099.” “I’m a 1099 employee.” All those things mean that the therapists is a business owner and not considered an employee by the traditional set of rules in the United States at least. And, there are rules in place for multiple businesses coming together to price fix, price gouge, create monopolies, etc. These rules are in place to protect the public.
We really get it. That isn’t what this feels like. Especially when you are working for a big company who creates all the rules and regulations for what and how you are doing things - but that is a conversation for another day. For today, when it comes to being contracted with insurance companies- you are considered a business. What does that mean?
You don’t get overtime
There are no salary caps
There is no group negotiation in the way that you are thinking about it.
You, as a business owner, have negotiating power for your individual business to say yes or no based on YOUR situation.
You, as a business owner DO have negotiating power with that insurance company. You have the right to push back, to ask for what you want, to refuse to sign contracts that aren’t sustainable. Guess how unions work in other organizations? They strike, they withhold their work until working conditions improve or the pay is sustainable.
In the case of a therapist in private practice- the way you “strike” is by refusing to sign contracts and by withholding your labor.
If therapists can’t create unions, what CAN they do to negotiate terms?
You can’t get together with other therapists across the country to set a minimum pay threshold for CPT codes before you all will sign an insurance contract- that would be illegal. BUT, you could get together with other private practice therapists and decide things like this:
We will learn how to run our numbers and figure out what is sustainable for our businesses.
We won’t say yes to numbers that don’t work for us.
We won’t pay employees less than a sustainable, living wage (that will have to take into account the cost of getting licensed and living y’all).
We won’t shame other therapists for setting fees that work for them.
We won’t shame therapists for dropping insurance contracts that don’t work for them, for any reason.
We will educate our clients about how to advocate for services through their insurance plans
We will take our labor to insurance contracts that ARE sustainable if it works for us.
We will be clear with professional associations what we need and withhold dues if they aren’t taking those steps
We will contact the insurance commissioner and report harmful business practices by insurance companies regularly
In other words, as individuals and as a profession, we need to find our individual and collective voices to really lean into what works for us. No more assuming that everyone who says no to insurance across the country has the same reimbursements, regulations, and privileges that you do. Remember, each state has its own laws, regulations, contracts, and reimbursement tables. Some of these CPT code reimbursement rates are based on ZIP CODES in addition to license designation.
What therapists CAN create unions in private practice?
The therapists who CAN create unions in private practice are the ones who are working as employees for the business owner. So, w-2 employees working for you could technically get together to form a union to negotiate for better working conditions, pay, etc. You can learn more about forming a union here.
What do therapists want and need from professional associations?
Let’s dive into #8: We will be clear with professional associations what we need and withhold dues if they aren’t taking those steps. You are eligible to join many professional associations- and those associations function completely based on your membership dues. What are examples of mental Health Professional Associations- there are a LOT of them. Here are just a few:
American Counseling Association (ACA): ACA is a leading organization for professional counselors.
American Mental Health Counselors Association (AMHCA): AMHCA focuses on the needs of clinical mental health counselors.
American Psychiatric Association (APA): The APA is a major voice in mental health and psychiatry.
American Psychological Association (APA): The APA is a large organization for psychologists with various specializations.
American Association for Marriage and Family Therapy (AAMFT):
American Academy of Child and Adolescent Psychiatry (AACAP):
National Alliance on Mental Illness (NAMI): NAMI is a grassroots organization focused on mental illness.
National Association of School Psychologists (NASP): NASP represents school psychologists and related professionals.
National Association for Behavioral Health (NABH): NABH represents behavioral healthcare providers.
In addition to national organizations, there are often state-level associations or chapters of the larger associations within each state. Texas Counseling Association, California Association of Marriage and Family Therapists are examples. These associations are often working with multi-million dollar budgets. For example, in 2022 CAMFT put out a job description reporting a $6 million dollar annual budget and $13 million reserve fund.
So back to diving into what you are looking for from your professional associations. Here are things that you could ask for:
Legal Advocacy for Expanded CPT Codes
Push for time-based CPT code options for couples/family sessions and for expanded use of prolonged session codes (e.g., 90837 equivalents) with the American Medical Association. Currently, the only option is for any session 26 minutes or longer. Learn more and take a survey to help this issue here.
Advocate for CPT parity between telehealth and in-person sessions across insurance panels.
Help on how to best report things to your local insurance commissioner
Helping bring large numbers of complaints together to contact insurance commissioners
Pre-written scripts and templates about how to report things to the insurance commissioners
Easy access to contact information for insurance commissioners for members
Model Letters and Legal Templates
Pre-written opt-out templates for therapists who wish to reject updated contracts.
Sample complaint letters to state insurance commissioners or the Department of Managed Health Care (DMHC).
Templates for patients to file grievances when they lose access due to dropped reimbursement.
Insurance Contract Analysis Support
Provide review templates or actual support reviewing new contracts (especially when changes are hidden or buried).
Host live workshops or office hours where members can bring contracts and ask legal/financial questions.
Create a running log of insurance companies and red-flag contract terms members can access.
Support in passing legislation that protects consumers and providers from insurance companies. Here are some examples:
Request regular, detailed reports on what insurance-related legislation or regulatory changes the association is lobbying for (or against).
Push for member-led oversight on lobbying priorities to ensure alignment with frontline clinicians’ needs.
Advocate for reimbursement parity between license types (especially in states where master’s-level clinicians are paid drastically less than psychologists).
Demand action on ZIP code and region-based disparities in CPT code reimbursement rates.
Encourage them to work with state insurance commissioners to address inequities in provider compensation.
Ask how much of your dues are going toward insurance reform vs. other initiatives.
Ex. Texas Prompt Pay Act that puts fines for companies not paying promptly for properly filed claims.
Illinois Reducing the statue of limitations on clawbacks from 18 months to 12 months (many states have zero statue of limitations)
Tracking & Reporting Tools
Develop and share trackers where therapists can log denied claims, clawbacks, unpaid sessions, etc.—to quantify systemic issues.
Offer data dashboards to share trends with the public and policymakers.
Public Awareness Campaigns
Lead campaigns that educate the public on how insurance practices harm access to care (e.g., ghost networks, low provider pay, session caps).
Use collective therapist stories to show how insurance issues are consumer justice issues, not just business problems.
Ultimately, if your professional association is no longer meeting your needs and aligned with your needs as a professional and business owner, it may be time to ask for what you need, withhold your dues, or look elsewhere for the support.
Back to Jessica and Indiana Therapists
Jessica, ended her Facebook post with a call to arms asking anyone on her friend’s list to do the following:
“Call/Email your legislators. Call your HR department & complain about Anthem if you carry an Anthem or Carelon plan, Contact the state insurance commissioner, Tell everyone you know and get LOUD. We are one of the most underpaid providers in healthcare - we cannot take a 56% decrease and afford to keep our doors open, lights on & feed our families.”
We could not agree more Jessica! We need to start talking about these issues publicly. We need to be honest about what is happening and not just shouldering all of the burden on ourselves and our practices. We need to stop drowning in debt, letting our partners subsidize multi-billion dollar profits for companies and their shareholders. You matter. You deserve to have a livable wage. Ultimately, unfortunately, you are your best advocate.
Top 10 Ways Therapists Can Protect Themselves from Insurance Chaos
Only Say Yes to What Actually Works
Don’t sign contracts that don’t make financial or clinical sense. If the math doesn’t work, it’s not your job to subsidize a broken system.Know Your Numbers Cold
Calculate your minimum sustainable rate. Understand your time, overhead, and what you need to pay yourself and your team fairly.Diversify Your Referral Sources
Don’t put all your eggs in one insurance basket. Build a steady stream of referrals through your website, word-of-mouth, local networking, and aligned partnerships.Block Time for Business Every Week
Protect a recurring time slot for reviewing contracts, tracking claims, reading policy updates, and assessing your metrics—not just clinical hours.Read Every Contract Like It’s a Paycheck (Because It Is)
Don’t let legalese intimidate you. Look for rate changes, termination clauses, payment timelines, and policy shifts. When in doubt, get help.Build a Clear, Differentiated Brand
Stand out so clients seek you out because of your niche—not just because you’re in-network. Your specialization is your superpower.Keep Receipts & Paper Trails
Save all correspondence with insurance companies, especially contract updates or reimbursement changes. You'll need it if you want to file a complaint or negotiate.Connect with Other Therapists (Without Price-Fixing)
Collaborate to share experiences, strategies, and resources. We need transparency—not competition—to survive these shifts. You can join Therapists in Indiana unraveling this situation here on a private Facebook group.Know Your Rights & Report Violations
Learn how to file complaints with your state insurance commissioner. One complaint might not move the needle—but 1,000 could.Invest in Your Sustainability
Whether it's upgrading your website, getting business coaching, or shifting to private pay—don’t wait for the system to get better. Build the practice that protects your energy, income, and impact.When it doubt call to check
Call Carelon and ask if you are in network, if your state has or is integrating Carelon. Phone number: 800-397-1630. Option 4, then option 3 to check your in-network status. In Indians, you can also contact alisa.phillips@carelon.com
What about you? Did we miss anything? Do you have suggestions about how we can improve the system? Email help@zynnyme.com We’d love to hear from you!
About the Author
Miranda Palmer, LMFT, is a business coach, educator, and co-founder of ZynnyMe. A former private pay therapist who built a recession-proof practice, she now helps mental health professionals create sustainable, ethical, and profitable businesses. Miranda is also the co-creator of Business School for Therapists, a year-long coaching program designed to help therapists build practices that truly work- for them and their clients.
👉 Ready to protect your practice from systems that undervalue your labor? Download the syllabus and join the interest list here.
