The key legal and economic goal of a privately owned health insurance company, is to become entrenched as a legally required intermediary between patients and the “medical cartel.” So functionally the optimal approach for an insurance org is to ensure that they are only required to reimburse for expenses that are mandated by law. Then the trick is to reduce the number of mandatory payments through regulatory capture and obfuscation. See: Medical Biller role at each hospital and lack of consistency transparency etc…
Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.
So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.
That's not really accurate from a legal or health plan perspective. Therapists aren't physicians but they do have somewhat similar (though lower) legally mandated licensing requirements.
Therapists are considered healthcare practitioners. They have NPI numbers. They can submit claims for professional services to payers using NUCC 1500 forms or X12 837P transactions, just like physicians.
Therapists can choose to join health plan provider networks, just like physicians. On most health plans even out-of-network therapy is covered, but the patient financial responsibility may be higher. Mental health parity with medical benefits is legally required (although some payers aren't fully compliant).
There is a legitimate shortage of licensed therapists in many areas because education is expensive and reimbursement rates are low. Most therapists still work in small, independent practices rather than as part of large health systems so dealing with insurance billing is a huge hassle and overhead. Thus many therapists don't join health plan networks and require patients to pay directly.
Therapists are not considered part of the medical cartel because they are not required to go to medical school or pass the licensing process for “Doctors.” They can’t increase the service costs unilaterally into longer term revenue. This is why it’s trivial to find a covered psychiatrist - because they legally prescribe medicine which is the best possible outcome for an insurance carrier - their equivalent to SaaS margins.
So therapists aren’t legally “Doctors” and as a result they do not have the legal avenues to create an invoice that a health insurance company would accept as mandatory to pay by law. So there’s only downside to an insurance provider for this.