Ohio Counseling Conversations

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

• Ohio Counseling Association • Season 2 • Episode 35

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The biggest behavioral health workforce in Ohio is paid the least—and it’s not because counselors lack skill. We pull back the curtain on the legal and structural gears that keep reimbursement low: antitrust limits that fracture our voice, opaque contracts with nonnegotiable rates, paneling delays that outlast statute, clawbacks that drain small practices, and documentation games that reward downcoding over good care. With guests Mike Desposito and Derek Lee from OCA’s Insurance Advocacy Committee, we walk through real data from Ohio and neighboring states, explain why “parity” without enforcement changes nothing, and make the case for solutions that match the scale of the problem.

Instead of waiting for one-off legislative wins to trickle down, we map a path to durable power: forming trade associations to pool funding, counsel, and lobbying; building clinically integrated networks with shared governance and data so counselors can legally negotiate value-based contracts; and teaching essential business literacy so practice owners stop absorbing systemic risk alone. We also connect the dots from underpayment to access—how burnout, administrative burden, and cash‑only shifts create ghost networks, longer waits, and deeper inequities for families who already pay premiums but can’t find care. Dignity for counselors is dignity for clients; restore one and you protect the other.

You’ll leave with a clearer view of what’s broken and a practical playbook to start fixing it: join and fund organized advocacy, document denials and delays, file complaints together, and support enforcement that has teeth—published penalties, real audits, and transparent timelines. If we want timely, affordable mental health care across Ohio, we can’t stay vendors at the mercy of rate sheets; we need to become integrated partners with a unified voice.

If this matters to you, share the episode with a colleague, subscribe for more advocacy deep-dives, and leave a review telling us where you want the movement to go next. We've included links and flyers you can share with your colleagues below too:

IAC Resources:

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SPEAKER_00:

Welcome back to Ohio Counseling Conversations, the podcast of the Ohio Counseling Association, where we amplify the voices shaping our profession. Today we're diving into an issue that impacts every counselor, every client, and every community in Ohio and beyond: insurance reimbursement and provider advocacy. Counselors make up the largest segment of the behavioral health workforce, but we remain the lowest 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 our profession. To help us unpack these challenges in the path forward, we're joined by two members of OCA's Insurance Advocacy Committee. They've been on the front lines of monitoring reimbursement trends, pushing for accountability, and helping counselors understand what's at stake. We'll talk about systemic discrimination in reimbursement, barriers created by antitrust law, and why trade associations and clinically integrated networks may hold the key to lasting change. Most importantly, we'll explore why this fight is not just about provider pay, but about mental health equity and ensuring that communities across Ohio have timely, affordable access to care. We typically reserve a common question for our guests at the end of the episode about what conversations counselors in Ohio should be having with each other or with their clients. And today's guests made the case for today's conversation. So it's going to be our focus today. Today we are joined by Mike Despacito and Derek Lee from the Insurance Advocacy Committee of the Ohio Counseling Association. Gentlemen, thank you so much for joining us today. We're excited to have this conversation. Although, you know, from speaking with you, it might be a little heavy, but it's an important, meaningful conversation. But before we get to some of that, please share a little bit about yourselves with our listeners.

SPEAKER_04:

Yes. So my name is Mike Desposito. I am the current chair of the IAC committee for insurance advocacy. We call it Accountability Committee. And I also represent counselors on the Ohio Behavioral Health Providers Insurance Advocacy Committee. So kind of like the larger version for all of the allied fields.

SPEAKER_00:

Wonderful, wonderful. Thank you for joining us, Mike and Derek.

SPEAKER_03:

Yeah, my name is Derek Lee. I'm a professor for Texas Tech University Health Sciences Center. And I've I've had practices in Ohio for about 15 years now. Ohio's where I've been for, you know, I did grad school, and having practices, insurance has been a really key issue. So that's how I got involved in IAC a half a dozen years ago. It's really difficult to have equitable health care for people in Ohio if we don't have really good relationships working with insurance.

SPEAKER_00:

Wonderful. Well, we're so excited to have both of you here today. And to get us into this conversation, Mike, can you start us off and share like why insurance advocacy is such a critical issue for counselors right now?

SPEAKER_04:

Yes, I find this is this is probably going to be a heavy conversation because really what I'm noticing now is counselors are caught in what I would say is a crisis of imagination. We have a sizable share of the behavioral health workforce, and yet the average counselor makes something like$35,600 a year. Whereas other, and that's including that we have to complete 60 credit hour master's degrees plus our internships and supervision and so on. When you add in then how other master's level professionals command salaries of over$100,000, typically, it just creates a major difficulty for us as counselors to survive. And what really irritates me about this is this isn't a lack of competency. The more I'm in this and the more we've been fighting for insurance advocacy, what we have learned is that there is a legal systemic structure set up to disempower and strip us of our inherent dignity as counselors. And since I've assumed the role as chair of the IAC, Derek was originally the chair, so I appreciate him for walking so we can run now. And now working with other Allied professional counseling associations and other groups across state lines, including Kentucky and Indiana, we are seeing and have documented moment after moment across the country where insurers are slashing our provider rates and rolling back payment increases. So this isn't just a small problem, it's a national problem. That then creates a broken system that fuels burnout and all the things we're talking about in our field. And so, really, our goal today for this podcast is, and what I want every counselor to know and to that's listening right now is I want to start reimagining our relationship with insurance and to begin building solidarity instead of what we'll talk about is we are really a patchwork of often competing providers and to begin moving towards an integrated solution to address this problem.

SPEAKER_00:

Yeah. And like gentle plug, if you are listening, like share this with people because it is such a meaningful topic and so important to the work that we do as counselors. Now, counselors make up one of the largest groups of licensed professionals in the behavioral health workforce yet. Tend to be the lowest in re reimbursement rates. And Derek, like from your perspective, how did this inequity come to be?

SPEAKER_03:

Well, let's start with the difficult truth that's essential in making this shift a reality. Counselors are good people and helpers at heart, which unfortunately sets them up to be taken advantage of. We live and do business in a world that's capitalistic, meaning that it's based in supply and demand. We've watched the world increase prices and raise rates dramatically over the last several years, increasing the cost of living all around us. I actually pushed to increase rates as a profession during COVID when our value was finally being recognized. And our field told me that it was unethical. So to borrow Mike's phrase that this is a crisis of imagination and disempowerment, it's been normalized in how it undervalues our profession. We have to become more dynamic as a profession, not only as counselors, but as business people and participants in a capitalist economy. The way we approach business has allowed for insurance companies to treat us like vendors, driving down our price to improve their margins rather than treating us like partners. You know, we're struggling to survive in a system in which we're the underdog. And this position stems from those systemic and legal inequalities that Mike mentioned, not professional competency.

SPEAKER_00:

Yeah, crisis of imagination. That's gonna be probably the title here, right? Like, you know, we've seen some troubling trends like across the country, like you were saying, Mike, from Indiana's Anthem Cuts, Colorado and Kentucky Medicaid rollbacks. Which of these examples stand out most to you? And what are they revealing about the systemic devaluation of our counseling profession?

SPEAKER_04:

Yeah, so this will likely be the hardest part of this podcast to swallow. And I want to shout out actually one of our key allies that I've been working with here, which is the mental health insurance reform task force, which is started by uh founder Nicole Sartini. She's out in Kentucky. In one year, she has now done so much work between Kentucky and Indiana and is one of the major trailblazers who's really trying to reimagine a lot of this conversation. It is because of her that we were able to start combining data on this. And I think now we are over about 19 pages of just documented rate cuts across five years. So just to kind of maybe summarize quickly and then maybe hit a few key ones, if you kind of summarize the last five years, many of the cuts targeting everyday counseling sessions or telehealth, the slashing reimbursement is around 25 to 40 percent in different states.

SPEAKER_02:

Wow.

SPEAKER_04:

And that makes up it nearly impossible, often for small business practices to run.

SPEAKER_02:

Yeah.

SPEAKER_04:

California's one that I know was specific to telehealth. So for my telehealth counselors, there was an insurance company that was private that attempted to classify telehealth therapy on a lower reimbursement rate, even though it violated California's telehealth parity law. And even with medical intervention or intervention from the California Medical Association and clarification from state regulators, the company finally reversed it. But I just want to kind of draw a takeaway here, which is they still attempted to change it.

SPEAKER_02:

Yeah.

SPEAKER_04:

Even with the law in place. Ohio's the one that we're getting a lot of right now. I'm getting messages probably weekly from counselors, where there is this kind of scary letter where we get from a certain private insurance company that says we are monitoring your CPT code use. And we want you to know you're overutilizing the standard rate and you need to consider down coding. That's one that we're talking about at the higher level of the Ohio behavioral providers. So allied fields are also seeing the same thing. Indiana, as you indicated, that was the most recent one that was in the news where a private insurance company sought to create a new fee schedule to reduce the standard 53 plus minute session from$115 down to$65. That insurance company did come out, give them some credit. They did come out and say it was a miscommunication. However, the letters do exist and it was something that caused a major uproar in Indiana.

SPEAKER_02:

Yeah.

SPEAKER_04:

This is not including the Medicaid changes. Several states have already rolled back Medicaid increases, even though they promised them with budget crises across the nation. Often you're seeing across the board Medicaid cuts. And it's not just that the rates are being cut, it's these new administrative hoops we're running into that's also quietly driving down lower reimbursement rates, which we'll talk about in terms of down coding or clawback. Other words we'll define later, I'm sure.

SPEAKER_01:

Yeah.

SPEAKER_04:

My big picture I want people to take away from this is in five years, and I'm sure if we had more data, we would see it for decades, is we're seeing a systematic devaluation. Behavioral health is often getting targeted to cost contain. So, like we're just doing cost containment measures, even though there's a demand, because in most states, I think across the nation, there is a mental health crisis.

SPEAKER_00:

You weren't lying when you said that question was gonna This is a tough podcast. Yeah. Derek, even when cuts are reversed after these advocacy efforts, what do you see as like a long-term impact that these threats are having on providers and their clients?

SPEAKER_03:

So even when the cuts are reversed, the very act of the cuts is a shot at the individual and the profession. It's a it's a systematic devaluation that impacts how we think about ourselves and the profession. Think about how you would respond to a client continually being devalued by a partner. We know the psychological impacts. But on the greater stage, these changes undermine the finances of a business and can destroy a small business, which is what we all are. You know, Mike actually just talked about payments are withheld and then it's reversed. What would happen to you personally, to your personal finances, if 40% of your income were withheld until next year? Most people would default on their mortgages. They they would they would lose they would lose ground, and that that puts businesses under. We'd like to think of ourselves as counselors, but in the marketplace, to the government, to the IRS, we're businesses. And we have to act as such. Even when reversed, these cuts threaten to destabilize the practices. They they drive fear and they push counselors out of the field. And I say that quite literally. I have three longtime friends that I met as counselors, and through counseling, who all have left our profession and now are educators. They're in software and real estate. We often place ourselves and our roles as helpers ahead of being practice owners and small business people, which is often argued as ethical, but in reality, it undermines the value of our business and what we do. Our inherent dignity cannot be sacrificed in our efforts to help other people. So when we think about things like self-care, how much of our efforts are directed towards stress related to insurance and finance? Wouldn't it qualify as proactive self-care if we were to start taking care of our businesses in a way that they became less stressful? We are put in a situation by the free market and the legal system that force us to come together and to push back as business people. And we're simply looking for equitable treatment and compensation.

SPEAKER_00:

Yes, yes. So, Derek, tell us more like how you see this discrimination playing into workforce shortages and burnout. Like you mentioned your friends, like how do you see this impacting counselors in the profession as a whole, like with shortages and burnout?

SPEAKER_03:

Well, you know, we could argue that the structural discrimination impacts every level of what we do. You know, it starts with working our fingers to the bone to see as many clients as possible because when you're underpaid, you rely on volume rather than value in your contracts. Then that work is being done under constant fear of clawbacks and insurance audits, which feel impossible because we work within a system that has ever-changing expectations for the documentation. The notes are not specific enough. Then when you get more specific, you're just giving them ammunition to pull more things apart. Pretty soon you spend about three additional hours trying to justify the original one hour that they paid you. And then this leads to the next stage where the rates place us at a disadvantage as we can't afford the same legal assistance that they have in-house. Getting paid with premiums that we earn for them and they withhold from us. They have a department of lawyers to keep money in their pockets and us broke, separate, and scrambling to keep our acorns before winter sets in.

SPEAKER_02:

Yeah.

SPEAKER_03:

You know, money and legal influence has set a legal premise that prevents us from discussing reimbursement while allowing insurers to discuss that same reimbursement. Again, this creates a cycle in which we stay underpaid, we can't afford representation, and that cycle of lack of representation was actually recognized by the Iowa court system, who acknowledged that counselors have no power to negotiate with insurance companies. This was said at the state court level. Yeah, I guess. Please think about that for a minute. We have courts acknowledging the disparity, and we're still not getting assistance. And it's because we don't have legal standing, we don't have representation because that costs money that we don't have.

SPEAKER_00:

Sounds like they it was built to do that, huh? Yeah.

SPEAKER_01:

Precisely.

SPEAKER_00:

Ugh, yeah. Mike, it's can you talk about like the private practice side of this too, especially those with maybe smaller practices who are generally more disadvantaged than some larger hospital systems?

SPEAKER_04:

Yeah, I mean, I can even speak to my own practice. You know, I uh so my partner and I run a small private practice in Canton, Ohio. We're a two-person outfit and we have some independent contractors who are getting their LPCCs, independent license. Derek's exactly right. When you think about these larger systems, legally created systems, they have entire departments dedicated to billing and negotiation. I don't think there's a week that goes by that my partner and I are maybe on the phone for 10 hours a week, in addition to our already seeing billable client hours plus supervision. And most of those 10 hours of calling insurance is to maybe chase down payments or chase down if there was a clawback or to just call an insurance company for guidance, I'm mostly spending that time on hold. So when you start kind of digging into this, independent counselors, we often, when you think about negotiation of contracts, you're just given this contract. And we'll talk about how intense these contracts are. You're kind of told to take it, like this is what's good for you, or you don't get to work with our insurance panel. They often have opaque or non-negotiable rates, and many times we won't even be able to find the rate on the contract, depending on the insurance company. You have to almost ask for it. It's a separate form.

SPEAKER_03:

To accentuate what Mike just said, I'm gonna jump in for a second. To accentuate what Mike just said, I've gone back to insurance companies to ask them to change terms in the contracts, and they literally chuckled, saying, This isn't up for negotiation. So when he says you we we really can't, we literally can't. Sorry, Mike, keep going.

SPEAKER_04:

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 a small, small private practice. One common boilerplate, one that's being kind of snuck into a lot of insurance contracts, is this 24-hour rule where you in 24 hours have to see a client if they are seeking mental health care. And now, if you think about that, that's essentially how a hospital system runs. And so for us, we don't have the capacity to be able to do that 24-7. But yet then I'm in violation of my contract. So if I sign something that puts me in violation, then there's this whole issue about is that you can see how this just becomes a cycle.

unknown:

Yeah.

SPEAKER_04:

And that's the other thing. Like if a reimbursement rate gets cut, we're gonna feel it immediately. Because as a small business, I again, different percentages of clients have different insurances. I'm paneled with different insurance companies. But if one of the larger ones, let's say, were to change how they reimburse me, that could potentially make it very hard for me to function as a small business, at least. If not, if it's a major change, like with the change hack, if everyone remembers the change hack that happened, I didn't get paid for about five months.

SPEAKER_02:

Wow.

SPEAKER_04:

And so, you know, when you kind of start doing the math on that, and I think there was a class action lawsuit, many counselors jumped on on that. It's financially unsustainable if we even have one rate change for many counselors out there. And I know a lot of just small independent counselors that beat paneling is makes or breaks the difference. And we'll talk more about actually paneling and why we still choose to panel, because a lot of counselors are choosing not to. I know a colleague of Derek's and and someone I presented with, Dr. Lynn Jennings, wonderful woman who published one of the leading books on private practice. She did an ACA focus group on private practice and identified that a lot of private practices across the nation are failing. And one of the major primary reasons is because people are struggling with being able to just deal with insurance issues.

SPEAKER_00:

Like that these are all really important things that, you know, I belonging to different social media groups and seeing different conversations that counselors have been having, or even just seeing stuff on TikTok or wherever about clawbacks, like it's it drives people to other options, sometimes other careers, but I'm just like firing on all cylinders, having a lot of thoughts as you both share. You mentioned Mike, like rates being opaque and non-negotiable. Derek, what do you feel like are some of these biggest accountability gaps because of some of these really vague things happening?

SPEAKER_03:

Uh it really begins with lack of training, lack of transparency, and legal loopholes that not only allow insurance companies to be vague and not provide information, but conveniently prevents them from providing direction to their providers. So, for example, most insurance billing is learned on the job. While we work in the same offices, counselors are trained in parallel to provide services, not to bill for them.

SPEAKER_02:

Yeah.

SPEAKER_03:

So when claims are rejected, counselors will often ask, I've done this. We often ask insurance companies for direction and are told that the insurance companies cannot provide direction on billing. So we are left in the dark. Although they they can tell you what not to do, they can't tell you what to do. But anyone who's ever worked with children knows that this is a foundational and fundamental problem. No creates frustration. We we need to be directed in what to do. However, the same insurance companies that cannot provide direction often downcode or recommend down coding, which is providing the exact direction they often deny when asked. So this just shows that they can only give direction when it results in them saving money, not cutting a check. They can't tell us how to get paid, but they can tell us to go, they can recommend to go from a 908.37 to a 908.34. And I will challenge any insurance company out there to show me documentation of a time that they recommended someone use a 908.37 and do a one-hour session instead of a 45-minute 908.34 because it was consistent with the evidence-based model that they're reimbursing for. I will challenge anybody, show me documentation of that. It doesn't happen. They're not looking for best practices, they're looking for cost savings.

SPEAKER_04:

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 to me is counselors, right? We are very ethical as a field. We care about helping our clients. Like that's often when I talk to counselors, they say the reason I take insurance is because I care about my clients. And, you know, when I look at, we're trying to do the right thing by asking how to do it correctly. So then we can create an easier way for people to get help. And we are being told, sorry, we can't help you unless it benefits us financially.

SPEAKER_00:

Lots of thoughts, some words I can't say here. But Mike, can you share some real examples of how these delays, denials, seeking prior authorizations have like disproportionately impacted smaller practices?

SPEAKER_04:

Yes. So as the chair of the IAC committee, I probably hear this several times a week from counselors just reaching out to me across Ohio who are running into kind of the same systemic barriers that we're all talking about today. I'm gonna try to define a few, but one of the things that I'll make sure to provide at the end of this, and what we did as counselors that we took to the higher Ohio Behavioral Health Provider in advocacy group, we all they're also seeing similar things. But what we did is we found there's at least 17 of these major barriers that are impacting all counseling practices in some way, shape, or form. The most common that we're seeing right now that I can think of direct examples is paneling delays. So, like counselors who are trying to seek paneling, they're trying to get a contract with an insurance company. We're seeing and hearing that it can take months to almost a year sometimes for some people to get credentialed. There's often little communication in it. And this is especially painful considering Ohio, as I've learned from our allied friends in other states, we actually have prompt pay laws. And that's its own unique thing, which means two things. First, we should have our payment typically within 30 days of our submission, unless it's rejected for something that we did poorly on the forum. We may missed a box. But even if you submit the credit claim, it's typically 30 days. Credentialing should be a 90-day process. That being said, I now hear that that law is being interpreted uh pr very liberally by some insurance companies that some may assume it takes 90 days per step of your paneling. And I've even heard of some people being told the 90 days doesn't start until they invite you to the insurance panel. Now, I've been working in this field, I, you know, I'm probably newer than maybe some other counselors out there. I don't know many counselors who have ever been personally invited to panel with an insurance company.

SPEAKER_02:

Oh man.

SPEAKER_04:

The other one that I think just to kind of throw, and like I said, I'll share this list so everybody has it, but clawbacks, which is retroactive denials where insurance companies demand repayment months to even years. It depends on the insurance company. There's laws about that, that were already approved and delivered. So you as a counselor could eight months after think everything's good, and then boom, they could be auditing and clawing back several of your sessions that maybe, if you're a small business, have already spent into other places of your business.

SPEAKER_03:

Actually, speaking to that, I had that happen about a year ago. An insurance company came after me wanting to do clawbacks that were five years old. That is what that is outside of the realm. They they wanted to negotiate because they knew it was going to cost me$500 an hour for a reasonable attorney to fight them. And they actually pointed out to me that it's cheaper to pay them than to hire an attorney. So it speaks to that legal disparity again. We don't have representation.

SPEAKER_00:

Yikes, yeah. Oh man. Appreciate you sharing like your own examples too, because I think it it matters that we know it's like happening to all of us. It's not just something you heard or saw on the internet. It's like this is real. One of the lesser discussed issues that you both had shared with me were like antitrust laws and how they prevent counselors from collective bargaining. Mike, can you explain a little bit more in practical terms what that means for the counseling profession?

SPEAKER_04:

Yes. And this is really the boogeyman when it comes to how we talk and how we deal with this problem altogether. And this is actually why, and I'm sure Derek, you might feel this way, because again, he was the chair last year, I see, of really banging our heads against the wall, trying to find a way through this. Because it feels like there's no way out many times. As independent providers, we are legally, and I want to make sure this is clear for everybody, and I'm gonna explain why this is important, we are legally prohibited from joining together and negotiating reimbursement rates as a group. And if we tried to sit down at the table with insurers and demand fair pay collectively, it would be considered price fixing under federal antitrust law. So even talking about, and this is I want to make this clear, talking about the dollars and cents, the exact reimbursement rate you received in your contract with other providers can cross the line into an antitrust violation. Now that's important because I see a lot of people online, and I don't think they're all counselors, but this doesn't matter, all behavioral health providers on TikTok or social media that are often venting, putting themselves at risk of legal trouble because they're saying how much they're getting paid. So we can't even talk about how we're disparaged. Meanwhile, and this is what we're trying to talk about a lot today big hospital systems, larger agencies, larger integrated networks can negotiate. As a block legally, they can legally negotiate their contracts in a legally structured way because it demonstrates shared government governance and integration. And that's often why they walk away with larger or higher reimbursement rates than the average small counselor who's running their business. For small practices and solo providers, that legal framework will keep us continuously fragment, fragmented, and powerless. And often it forces us to accept whatever rate we have because we can't afford the lawyers, as Derek is saying, to cover the cost of this.

SPEAKER_03:

Yeah. So antitrust is just one tool in a toolbox of anti-competitive practices. As counselors, we can't discuss our insurance reimbursements with other practitioners or we're violating the federal antitrust laws. There was a caveat created several years ago forcing insurance companies to publish these rates. But again, they found a workaround. They put them in a large packet. And when I say packet, it's like this huge data packet that's too large for typical computers to open to even open, let alone work with. So for counselors to get these, we have to contract with tech companies to harvest them and extrap, you know, they pull the data out, which literally costs thousands of dollars that we don't have, just to see what the reimbursement rates look like and to not be isolated. I actually did buy some of those. So I do have data. And I can I can talk about what everybody in the state is being, I know exactly how much everybody in the state is being reimbursed by certain insurance companies.

SPEAKER_02:

Wow.

SPEAKER_03:

But it continues from there. So unless you've purchased that data, you can't talk about it. So but as it continues from there, you know, it includes association of health plans that have legislative access and financial power to create the influence. So while the while the health plans actually have these collaborative groups, they have a seat at the very table. They have influence on legislation. And we don't, we don't even have anybody in the room. They're at the table and we can't get in the door. So how can we actually be competitive when we can never enter the race? That's why things have to change. We have to figure out a way to get ourselves to the starting line. Exactly. There are ways to do it.

SPEAKER_00:

Yeah, yeah. You mentioned like some of these things passing, and then we know that even in state legislators, there's bills that are passed that are, you know, like seemingly really great and supportive, but insurers seem to find ways to work around them. Mike, can you tell us like an example of maybe where some legislation like this has fallen short?

SPEAKER_04:

Yes. And I want to start actually by shouting out that there are several provider-friendly bills. I'll provide it for the end of the podcast of these common provider-friendly bills right now that are in our state legislature. Everyone that passes makes our lives easier as counselors. So everyone, we want to get all the advocacy out on every one of these. However, many counselors I talk to and other behavioral health providers often describe, because here's the thing a law passes that assumes there's an enforcement. And so when I talk to many behavioral health providers, they will often report difficulties with the Ohio Department of Insurance and Medicaid. And when I meet with the higher group as the counselor in the allied fields, there's data that shows that many providers either don't know how to file a claim if an insurance company is violating one of these laws, or they're hesitant to do so because there's fear of legal or potential financial blowback.

SPEAKER_02:

Yeah.

SPEAKER_04:

Are you painting yourself as a target? That's a real fear many counselors have. And so filing a this is a good example. You file a claim with the Department of Med Medicaid, it requires you to navigate their website. And many providers feel it creates a conflict of interest and it's a whole barrier to just navigate the website. So while I appreciate Ohio, we have a department of insurance. I've learned not all states have the kind of place, it's also not really how do I want to say parity oversight. Let's just maybe use that as an example. It's another issue that maybe we can talk about, is while it exists, the Department of Insurance at Ohio Moss, and even the state publishes annual reports and tracks complaints, they say there's no public fines or restitution that's listed publicly. So, you know, when you find that, yeah, there's these parity requirements and they're technically enforced, there's little visibility of accountability. I can't find something to point to today.

SPEAKER_02:

It's not transparent. Yeah.

SPEAKER_04:

This is where I want to shout out our good ally in Kentucky, Nicole Sartini, the founder of the Mental Health Insurance and Reform Task Force. That's a grassroot organization that started in Kentucky because they're sick of how they're being treated. And they are doing a lot of similar things we're doing to try to fight for parity, legislation, litigation, and education. And I really appreciate the work they're trying to do because in a year they've already educated over a thousand practitioners and they have grouped in with Indiana, especially after that most recent insurance debacle. So what I find and why we want to bring this to Ohio is there are groups that are beginning to pop up that are having the same shared conversation that we are going to have today.

SPEAKER_00:

Very important conversations. And I know that you have some resources that will link that also go with that reform group that we can share that information as well. Derek, what do you think about like what's making structural solutions like trade associations or clinically integrated networks more durable than just relying on some of these legislation pieces alone?

SPEAKER_03:

We're here today for this exact reason. You know, this is a systemic problem that we need to address with a systemic solution on a state and a national level. We need to begin to reimagine how we're handling insurance contracting and reimbursement. If we've been unsuccessful as individuals for years, why are we not coming together as a field? Individually, we don't have the money to hire high-priced lawyers to represent us individually or with legislation. But if we come together, we really can do some amazing things. I don't have a half million dollars to make systemic change. But if we really want to make change and know that we can be agents of change, I'll bet that there are a thousand counselors and practices out there that are currently losing the battle on their own that could cough up$500 each. And all of a sudden, we're in the fight with actual representation. We are players, and it just builds from there. This is the power of creating a formal trade association. It allows for members to contribute, to work together legally, and benefit their practices, which will eventually have ripple effects throughout the entire field. Think of how easy it would be to make an argument in Iowa if only you can afford someone to make the argument. This is a good time to revisit a statement from earlier which ties into this. You know, nobody is running to help counselors. They expect us to pay for their time. We don't have allied professions pushing for better treatment of counselors or hospitals pushing for increased reimbursement for our profession. We have to do what we preach every day. We continually push clients to advocate for themselves. We often talk about how we as a profession need to advocate for those who are disadvantaged. When do we start advocating for ourselves? I published an article in counseling today demonstrating that counselors make anywhere from half to a third of what other professions with similar educations make. We rightly advocate for minorities, minoritized pot communities that have paid discrepancies of 15 to 20 percent. So why are we not advocating for ourselves who are disadvantaged by 50% or more?

unknown:

Yeah.

SPEAKER_03:

We keep fighting for everybody else while we pay the price.

SPEAKER_00:

In many ways, we pay the price. Yeah. Yeah. For those who maybe aren't so familiar with some of the terminology, Mike, can you explain what a trade association in the counseling context is and how that might change the game for advocacy, as well as like break down clinically integrated networks and why they might help provide counselors with more lever leverage?

SPEAKER_04:

Absolutely. And I want to shout out another thing I'm hoping that we can eventually link to this podcast when it's up, is I want to shout out the Ohio Counselors Association for Providers and Private Practice, OACPP, and Ryan put me in there, extra P. They are actually working with one of our colleagues who we've been working with, a lawyer, who is going to hopefully be providing this exact conversation for counselors for free, so they can begin to have these one-hour meetings and talk about like what is a trade association and clinically integrated networks, and again, how this is creating a systemic oppression. That's very important for us to continue to keep in our minds as we talk about this. But to answer your question kind of briefly, in kind of counseling language, a trade association acts much like a chamber of commerce. I know a lot of private practitioners go through chambers because they get health insurance that way, which a little perk of a trade association, you can group up and create, you can actually bid for better health insurance. But essentially what it does is it creates a unified voice, provides legal support, and fosters a professional solidarity in it. So again, I use that example of a trade association. These trade are, I'm sorry, a chamber of commerce, people know what chambers of commerce are. They kind of help the small businesses in that community, that county, or that city. These organizations can operate as nonprofits, even 501c3s, while still functioning as a trade association, advocating for interests of counselors. And by coming together under the structure, individual counselors gain a leverage that we often don't see alone, as we've been talking about today. Trade associations can also lobby state legislators. In fact, there are associations for insurance companies that are doing this exact thing against our provider-friendly bills. Just something to think about. And then, as well as it provides resources to help counselors navigate these challenges. And I'm starting to see these pop up a lot in Ohio. Often you'll see like MDs, so doctors and maybe counselors mixed together in something of that nature, who work together to improve often patient care, efficiency, and outcomes. CINs create this shared governance and structure and data framework. So data and contracts are kind of shared amongst each other, which allows them to bypass antitrust. So it allows them actually to lawfully negotiate collectively under that antitrust law. This is something that we're saying that we cannot do independently. So by reframing counselors from fragmented small businesses to an integrated care partner or integrated care partnerships, CINs give providers a seat at the table for these value-based contracts. We get shared savings. It allows performance-based agreements, which means we would see likely improved value in our services. But again, right now, being isolated, we operate in a place where there isn't really the ability to secure fair reimbursement while maintaining the access we give and the best practice to our clients.

SPEAKER_00:

So what steps would Ohio counselors need to take to begin building toward a CIN or a stronger association framework? Derek, tell us.

SPEAKER_03:

So counselors start by uniting with a common goal to be heard and reimbursed for the value that you provide to tens, you know, if not hundreds of thousands of people every day and millions of people every year. When I say uniting, I mean formally join the organization, put your name on the roster and help fund the efforts. We literally need the names on the roster to show our legislators how many of their constituents are being represented. And we need the funding to make sure that we have representatives at the table. So when I say that, there are a couple, you know, we've got a specific state representative. Everybody in her office knows my name, and they all know how to stonewall me. She will not meet with me. I've been banging on her door for a dozen years, but she views me as one person and one business owner, and I'm just a thorn in her side. But if I have a thousand small businesses in Ohio with me, if I have thousands of counselors, she's gonna listen because she counts on those votes in November. But right now, I'm just a pain in her rear. That's why we need literally people to get together. And when we say we we need this, we don't need tens of thousands of dollars from any one person. We can rely on the power of numbers. You know, a million dollars is a lot of money, but it's only$500 each if we can get 2,000 members. I don't have a million dollars, but I I can probably swing$500. And I'm not, I want to be clear too, I'm not offering like memberships or anything for$500. It's just an example of the power of working as a collective, you know, showing what's possible if we listen to our hearts, but leave with our heads. So, you know, beyond membership, we we need leadership, we need vision, and we need solid direction, most of which we we have very carefully cultivated over the past few years, which is how we ended up talking to you today. We also have connection to other states and regions and voices that had been heard nationally. If we can show them what movement looks like in Ohio, a national movement is not far behind. And I've been told that directly. People just need to see the direction. They need to see us take the steps forward, and they will be with us.

SPEAKER_00:

Yeah, someone has to start. You know, it's like the wave.

SPEAKER_03:

Exactly. Exactly.

SPEAKER_00:

Someone in this some section needs to start. You know, a lot of this conversation thus far has focused about provider pay, which let's be very clear, is incredibly important as you you've hit home on that. That like we need to make money. Like, it's why are we suffering because we're just like the empathic team, you know, on the field. And what I think we need to also like highlight is that this impacts our clients. Derek, can you tell us a little bit more about how underpayment of counselors does have a direct impact on communities and mental health equity?

SPEAKER_03:

Yeah, you're right. It's not just about provider pay, but pay has an impact on nearly everything that we do. There's that ripple effect. So let's start on the business side. I have friends that are doctors and dentists and even nurse practitioners that are going to conferences for continuing education in fun places like Vegas and Hawaii. They're maintaining their education with hybrid vacations. I also know counselors stressed about having to spend$50 for online CEU packages because their license renewal is pending. This leads to decline in continuing education and less prepared clinicians, really defeating the whole purpose of continuing education to begin with. And this ties to the personal finance piece. We know that people with financial struggles have high stress. It's tough enough trying to make ends meet. But when you have to make difficult decisions to do everyday things, like can we pick up a pizza and put gas in the car? That's real for a lot of counselors. I don't know any counselors that expect to be wealthy as a counselor, but they shouldn't have to have to figure out if they can pay for a child's sport or if they can go to a concert or two a year. They should be able to afford reasonable vacations and a reliable car. These factors compound to burnout. People leaving the field to do other things where they can work less and make more. Many love what they do as counselors. They just can't live under the conditions which are driven by this reimbursement debacle.

SPEAKER_02:

Yeah.

SPEAKER_03:

And this circles it back to client care. And we can speculate about the performance of undertrained clinicians or those struggling with burnout, but let's look at some simple facts. The Rural Health Information Hub, and I'll make sure you have that link, they have a map and it shows the counties across the entire U.S., in which every county in the U.S. it shows where they stand, whether they have a severe mental health shortage, somewhat of 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 say the least. There are literally entire states that don't have a single county without a shortage. Most states only have a county or a few at most that are not under a complete shortage. And this is the reality of the situation. The entire country felt the effects. What I'm talking about right now, everybody felt during COVID. Think back, you know, we don't like to talk about COVID these days, but think back five years when people would try to reach out for counseling and there was a six-month wait list. People were hoping to get in. And hopefully COVID never that doesn't reemerge, but we will have other situations in the future in which we have mental health crises. We have small ones all the time. And right now. Exactly. They're constantly there. So what that means though is that families every day are feeling the effects of the shortage. When we talk about where this spirals to, we have thousands of families, if not millions of families today, right now, as we're talking, that are suffering due to the mental health shortage. And the irony is sometimes that mental health shortage is because they had a great realtor that just sold him a house. He was the coolest guy ever. He used to be a counselor that worked with me, but he got tired of the grind and the work and you know the terrible conditions that are often created by the financial side of counseling. So he went to be really happy doing something else. And he's great because he's a good listener. He he understood what they wanted. And he made a he made an amazing realtor. But that was also a tremendous loss for our system. And families every day are feeling that loss, whether they realize it or not. So, you know, there are other things that need to be addressed, you know, things like the shift in care. You know, I've heard statistics as high as 90% in some areas, in that 90% of counselors are no longer accepting insurance and are cash pay only. Given that most people simply can't afford cash pay, this limits care to only those with means. Once again, marginalizing those that are not financially advantaged. We also have to acknowledge the fact that we're inadvertently letting insurance companies off the hook. They're still collecting premiums. It's part of the package. Those people are just not getting the services that they're paying for. Could you imagine a system in which you go through the drive-thru of a fast food restaurant and they don't give you the fries because they're out, but they still charge you for them. I mean, that's literally what's happening every day. People are paying for services that they can't get. But insurance has a get-out-of-jail free card because they can claim full rosters and point to insurance contracts that require offices, provide services within 24 hours, but nobody's holding them accountable to make sure that those offices can do it. It's the counselors being held accountable. You know, the old saying, stuff rolls downhill, and without representation, we're at the bottom of that hill. It's us and our clients that pay the price. Did you know that the CEOs of the six major national insurers earned a combined total of nearly$123 million last year? This is six individuals. Six people. United Healthcare's CEO Andrew Whitdy made nearly$24 million himself. Poor David over at Cygna, he only made$21 million. And Bruce at Humana scraped by at a measly$16 million. How did they get it? Well, we all know. Not ethically. I mean, I'd like to see counselors, and this is me being reasonable, but I think kind of modest. I would like to see counselors, you know, like a midfield making roughly$120,000 a year. And I think that's pretty modest compared to$24 million, especially when we're the ones that are actually saving lives and changing lives.

SPEAKER_00:

Mm-hmm. Mm-hmm.

SPEAKER_04:

Just imagine that.

SPEAKER_00:

We're we're working on it, right? That's that's what we're trying to do here. You know, I think it is so important to consider these things and advocate. And we know that the downside sometimes is that the providers get that burnout and say, you know what, I I can't keep doing this. I can't keep advocating because I'm not sure I can wait the time it takes to get to that$120,000. So, Mike, what happens when access to these providers leave the field because they are like, I just can't afford to keep at this anymore.

SPEAKER_04:

So in private practice, I work closely with my power partner and I want to shout her out. Dr. Katie Gamby won an award actually in in my county because really worked to successfully launch 14 new practices to address the provider shortage in my area. And that doesn't include the dozens of consultees that we work with, individual counselors and other private practice businesses across the state. And many of them have seen some success from the work that we've done. However, the most common complaint we get and the most common issue we get is real difficulties with insurance. The cuts to Medicaid is a real thing. Challenges trying to panel with insurers is a real thing. I believe there is someone I consult with who still has not contracted with an insurance company, and he started in January.

SPEAKER_02:

Wow. Yeah.

SPEAKER_04:

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 lose the ability to actually have quality care. Burnout nutrition, as you say, that leads to shortages, obviously, but it also leaves vulnerable populations without the support they need. I always look at, and I think Derek maybe kind of said it last, but I take insurance because I see it as a social justice issue. Because I think of myself, if I have insurance that I pay these huge premiums for, I would want to use my insurance.

SPEAKER_02:

Yeah.

SPEAKER_04:

I'm not against people who do private pay, and I'm glad when people can get paid their worth. I want counselors to have their dignity. I also want my communities to feel like they have a place to go. So ensuring fair compensation and reducing these administrative barriers, it's not just good for providers, but it's essentially keeping care accessible. So you're not having long wait lists and counselors walking away, all providers really walking away from using insurance, which creates ghost networks, a giant list that an insurance can provide you of places you can go. And none of them either exist or they can't take anybody for over a year.

SPEAKER_00:

Not one of the questions that we discussed ahead of time. So you can say, Marissa, we need more time. But how do you feel or believe like the counseling compact may contribute to some of these challenges? Or I mean support them. I guess like either way. I guess I'm just curious how you feel like the counseling compact may play a role in some of what we've discussed today.

SPEAKER_03:

Mike, I see you're muted, so I'll jump in. I I have a lot of concerns about the counseling compact. I think in spirit it's fantastic. And it's the direction we want to go. The problem I see is that we are trying to push it through so quickly to get more people in, and that we're not working to keep our standards high. And that's exactly that creates exactly the types of cracks in the infrastructure that insurance companies that's what they wait for. They count on those because when we suddenly have different standards, we suddenly have different groups, that gives them room to move in. And one of the other things we see is that if you know they don't have to negotiate with us when we're fighting with each other. So we need to unify. We don't need to just agree to the lowest standards so we can get everybody to the table because everybody's going to fight at the table. We need to increase our standards. We need to go in with a unified agreement that this is who we are as counselors. We have value, we are a valid profession, and we deserve to be at the table. So I love the idea of the compact. I have significant concerns with how quickly it's been pushed through. And I say that I compare it to the 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 at that and realize that faster isn't always better. You know, there's there's an old business saying you can have it fast, you can have it cheap, or you can have good quality, but you only get to pick two. So if we have it fast, are we going to sacrifice quality? Or are we going to sacrifice value? And I'll tell you, I don't see them pulling major dollars to the table. So if we're going to keep it cheap and do it fast, that says the quality is not going to be there. And that's my concern. I mean, I'm not, I'm not on the inside of that, and I'm not throwing this out as shade towards anybody doing it, because I think they're they're really doing the best they can to try to push it through. I also think sometimes it's good to slow it down and make sure that we're still we still have the same target that we started out with.

SPEAKER_04:

I want to echo a little bit of what Derek is. Is saying here because I I appreciate the compact. I believe portability is a real issue. And in terms of our conversation today, more counselors does not mean integrated counselors.

SPEAKER_00:

Right.

SPEAKER_04:

And so my hope would be, I guess this is where I want to reimagine even the use of the compact is could this be a way ACA could double down on this conversation?

SPEAKER_02:

Yeah.

SPEAKER_04:

I get concerned when I see, and I'm sure OCA members recently saw the survey come out that they are trying to maybe do away with the independent licensing exam.

SPEAKER_02:

Yeah, I did.

SPEAKER_04:

And so some difficulty I have is in terms of competency, will you see a change in how we do things? And to Derek's credit, I see insurance, at least weekly, if not daily, look for loopholes to undercut us because the goal is to save money. Remember, not to tell you how to bill. So I'm get I get concerned about these things. And I would encourage ACA and OCA to maybe create a task force or to do something around insurance reimbursement so we don't lose, as Derek's saying, the quality. We've been talking to many legal services over the past year, and integrated networks have been around for decades. So this is a conversation that is not new for people. However, I would say many counselors had no idea this exists.

SPEAKER_00:

Yeah, yeah. I appreciate you both being candid about it. Like I know that this was not a rehearsed or written question, but I think it's important to consider sort of one one other thing to think about too is the way the current compact is written.

SPEAKER_03:

We are talking about counselor advocacy. A lot of the states that that where we're changing the standards, people that are licensed as counselors are only licensed is licensed as counselors. They don't have degrees as counselors and they don't share the counselor identity. So for example, if another profession, if you've got a number of people licensed as counselors so that they can work at the master's level while they are, I mean, I'll just say it, while they're working towards a doctorate in psychology, how how invested are they in counselor rights? Or is this a transitional piece?

SPEAKER_00:

Right, right.

SPEAKER_03:

You know, so we really have to think about who we are bringing into the club and are they going to fight for what we're trying to do, or are they going to add to the segmentation that that insurance counts on to keep us divided?

SPEAKER_00:

It creates opportunities for more connection and like more conversations, but paradoxically can create opportunity to disconnect or or compartmentalize. Yeah, yeah.

SPEAKER_01:

Absolutely.

SPEAKER_00:

So again, I appreciate you being candid. I I, you know, I think there's a lot of excitement around the counseling compact. And, you know, to to your point, portability is important, but how does it maybe affect this conversation that we're having? I think is is equally important. So, Mike, you know, kind of coming toward towards the end of this conversation, if we had to speak to some policymakers who might be listening to this conversation, what would you say is like one action they could take today to enforce parity and accountability?

SPEAKER_04:

I would just start with exactly what you said is if you want counselors to continue delivering 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 Counselor Social Worker Marriage Family Therapy Board and countless clients that they serve. The public already knows that the mental health system is broken.

SPEAKER_02:

Yeah.

SPEAKER_04:

You have the power to reimagine it. That's the key today. Is do you want people, the people who are saving the lives today, to still be here tomorrow? Like Derek said, it would break my heart that the person who sells you the house could have been the one who could have been there for your family member in need. Do you let me just kind of say enforcing parity and accountability is how you become champions of this change instead of just defenders of often a status quo.

SPEAKER_00:

Definitely. For counselors in Ohio, Derek, like what are the most immediate ways to get involved in advocacy through OCA or or the committee that you both have chaired or are chairing?

unknown:

Yeah.

SPEAKER_00:

What would you say?

SPEAKER_03:

For counselors, we we have to embrace the fact that we cannot fight legalized systemic oppression alone. That's been demonstrated. The immediate step is to unite through OCA, through the Insurance Advocacy Committee, and by building a trade association or a clinically integrated network that gives us that leverage. Our power lies in solidarity, not as fragmented small businesses, but as a unified profession reclaiming our voice, our reimbursement, and again, going back to our inherent dignity. And I would actually expand that, you know, to the general public, you know, for clients, for families, for community members. Here's the truth. The only reason we work with insurance, and I say this, you know, for myself, owning multiple practices, not only in Ohio but in other states, but also knowing a lot of practice owners. The only reason we take insurance is because we want the public to have equitable access to care. I cannot tell you how many people have offered me twice what an insurance will pay me to be out of network. And it's really hard not to go that direction. But the minute I do, I know the 14-year-old kid struggling with suicidal ideation who relies on insurance will not get the same level of care. Counselors accept low reimbursement and crushing administrative burdens so that so that the public's loved ones can heal. But the weight of this legalized oppression pushes so many people out of the field. When counselors are underpaid, clients lose access. Dignity for counselors is dignity for clients. And and your support is going to be key to building a system that honors meaningful labor and ensures timely, affordable mental health care for all.

SPEAKER_00:

Another sermon. It's powerful. Mike, for the people we serve, like their families, community members, what's the message you'd want them to understand about why equitable treatment for counselors is a meaningful cause?

SPEAKER_04:

Yes, I guess let me answer that and then maybe add in a little bit to what we can do as OCA folks. Sure. To answer your first the question, counselors today, we talk a lot about social justice, but I want people to understand that we are under legalized systemic oppression. And we have to look at this as a systemic issue, almost like going like to a couple's or marriage and family therapy. It's a systemic issue and a system that strips away our reimbursement. Clearly, we have five years of data to back that up. Our leverage and too often our inherent dignity. But this does not have to be our future. I want counselors who are listening to this to begin to reimagine behavioral health care in a way that honors the dignity of both counselors and clients, where meaningful labor is valued and sustained. The evolution of our profession points us towards a collective strength. It's not just to fight back, but to fundamentally transform the system. This is about building real advocacy, not just symbolic gestures, not just a letter from a governor or something. It's about creating a healthcare landscape that everyone who knows it's broken now, something that they could believe in again and trust. Just imagine that. My comment to counselors who are listening to this, I want to put forth future things. Come to our insurance advocacy meetings. We're having these conversations monthly. Please come. We need as many providers as possible because we are doing a lot in a very short period of time. In terms of the OACPP, which is for private practitioners, they are trying, I believe they're going to try to make it free and they're going to try to have an ethics CEU two at two different times to help people's schedules because again, we're overburdened. One, I believe they're trying to do in November, and one in February, where they're going to bring in ethics of counselors and then bring in a legal expert to talk about clinically integrated networks and what a trade association is and why this is legal systemic oppression. And I also want to encourage OCA and ACA to begin to look at this conversation as one of the biggest things. Every counselor you talk to says they are low reimbursed. And what I think is difficult is no one understands how it's legal systemic oppression.

SPEAKER_00:

Yeah.

unknown:

Yeah.

SPEAKER_00:

Any final thoughts, Derek?

SPEAKER_03:

Yeah, I would just say join us. Join us. When I first got involved in this committee, we we had a steady group of three. And and now we now we literally have about 20 people coming in or out. You know, we we had some some major shifts in the last year or two. And what I would you know, what I want to say is join us. You can actually see change happening every month. And and the more people, the quicker and the bigger the change it's gonna be. So come join us because things really are happening. It's not just talk, things are happening. And and the more people that join us, the the bigger the party, and the quicker, the quicker we're gonna get where we want to go.

SPEAKER_00:

And if you're listening right now and you're thinking, maybe I should get involved, I want you to know like our show notes are going to have several links and a lot of information that will help you access that and and be able to get involved. And it's not just us trying to market the podcast, but this is such a meaningful conversation that if you feel like this is 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 the resources to get involved as well. Mike and Derek, thank you so much for joining Ohio Counseling Conversations today. Like I think I've said a million times, but I can't say it enough. This is meaningful and so important that that we're here having this conversation and sharing it with a large you know, larger listenership. And and I hope that we can keep it growing and and that we get a lot of people joining this effort as a result. Thank you again. And um, you know, come back. If there are more conversations to have, you guys are always welcome back.

SPEAKER_03:

Thanks so much. Thank you.

SPEAKER_00:

As we've heard today, the fight for fair reimbursement is about so much more than numbers on a fee schedule. When counselors are undervalued, clients lose access. When reimbursement structures are arbitrary and opaque, our workforce burns out and communities pay the price. Our guest reminded us that legislation alone won't solve this problem. We need structural advocacy, trade associations, clinically integrated networks, and a unified voice that reclaims our leverage in the system. So here's our call to action. For policymakers, enforce parity and hold insurers accountable. For counselors, unite through OCA and the Insurance Advocacy Committee. For the public, understand that equitable treatment of counselors is essential to protecting access to mental health care for your families and communities. Thank you to our guests for sharing their insight and passion, and thank you for listening. To stay connected with this work, visit ohiocounseling.org and check out the Insurance Advocacy Committee page. Until next time, keep advocating, keep connecting, and keep the conversation going.