07/01/2026
Sharing this from Galia Collaborative because it names something a lot of us feel but don't always say out loud.
Hello Mental Health is a primarily self-pay practice, so I see this from a particular angle. But these concerns go beyond self-pay vs. insurance. They're about how insurers, tech platforms, and the systems that credential us are getting tangled together and what that means for your privacy and your choices.
Insurance can be a doorway to healing. Technology can be a helpful tool. Neither should quietly replace your right to real privacy, informed choice, and human connection.
Choosing to seek care out-of-network is a privilege. For most people, insurance is the only feasible optionโ which is exactly why what is happening behind the scenes matters so much.
Bear with me.
Iโm going to name clearly at the outset that Galia is a self-pay practice. You deserve to know the position from which I am framing my concerns.
After years of working inside the insurance ecosystem, I opted out for Galia. This was a decision that weighed heavily given how it restricts access to care. But it also weighs heavily to operate within a system about which I have serious concerns.
Many people want or need to use insurance. Some donโt even have that option. There are no easy answers, thatโs for sure. The system is broken.
1. Clawbacks have been happening:
Clawbacks are when insurance companies can audit therapists and demand repayment for sessions that already happened โ sometimes years later. This might happen because they review the case and decide (without meeting the patient or having the appropriate credentials to decide) that the patient didnโt meet their criteria. These "clawbacks" can amount to tens of thousands of dollars.
This is a financial risk that can sink a therapist and forces many to leave insurance panels. That means fewer in-network options, longer waitlists, and less continuity of care for you.
2. Personal information has become valuable data.
In 2023, the FTC found that BetterHelp shared users' sensitive health informationโincluding email addresses, IP addresses, and answers to personal health questionsโwith advertising platforms including Facebook, Snapchat, Pinterest, and Criteo, despite promising to keep this information private.
Mental health information entered into apps isn't always protected by HIPAA. Some apps and platforms fall outside HIPAA's protections altogether, meaning your information may be governed primarily by the company's privacy policy and could potentially be shared with third parties in ways many consumers don't fully understand.
3. The database that controls therapist access is now owned by insurers.
Most therapists who accept insurance have to use a central credentialing database called CAQH (recently renamed DataSpring).
For years, it operated as a nonprofit. In 2026, it became a for-profit company owned by major health insurers, including companies affiliated with UnitedHealth, Aetna, Cigna, and Humana.
Why should patients care?
The same insurance companies that decide:
โข which therapists join their networks
โข how much they reimburse them
โข which therapists appear in provider directories
now also have ownership of a major piece of the data infrastructure that sits at the center of provider credentialing.
That's a tremendous amount of influence concentrated within a small number of companies.
It doesn't automatically mean something harmful will happen. But it does raise important questions about transparency, competition, and who holds power in our healthcare system.
4. Insurers are steering more patients toward chatbots.
Insurers and healthcare systems are increasingly promoting digital mental health tools and AI-enabled support. In some cases, these tools are offered before or instead of evidence-based therapy.
This is concerning because a 2025 Stanford study found that AI therapy chatbots can provide dangerous responses, reinforce stigma, and fall short of the standards we expect from human therapists in certain situations.
You deserve to be an informed consumer of your care.
โข Itโs important to know how any app or platform is using your data and whether it's HIPAA-covered.
โข If your in-network options feel impossibly thin, know that's a systemic failure.
โข If an insurer suggests an app or digital tool, ask whether it's meant to replace or supplement therapy.
โข If insurance is your access point for therapy, know it can absolutely still be a doorway, just walk through it with your eyes open.
The bottom line is that insurers, healthcare corporations, and telehealth companies are becoming increasingly intertwined with the platforms that deliver mental health care.
The company paying for your care may also influence where you receive it, which tools you're offered, and what kinds of treatment are incentivized.
As these lines blur, it's worth asking: who is making decisions about my careโand whose interests are they serving?
Insurance can be a doorway to healing. Technology can be a tool. Neither should replace your right to informed choice, privacy, and human connection in your care.
