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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:

• Counselor Insurance Advocacy Survey
  • https://docs.google.com/forms/d/e/1FAIpQLSd2nN_z2l20sIoaKcd1ydyEt2bp-40RO0ZTbO77JKAkOlUncQ/viewform
• Derek Lee Counseling Today Article
  • https://www.counseling.org/publications/counseling-today-magazine/article-archive/article/legacy/it-s-time-for-a-financial-change-in-counseling
• IAC Flyers for Provider Friendly Bills, Survey, CEU Opportunity(pending), and Mental Health Insurance Reform Taskforce
  • https://drive.google.com/drive/folders/1OgneHYtFEfY_h-cRAhqjKEButrSZ6zdb?usp=drive_link
  • Please note the CEU opportunity is related to continuing this conversation and is being spearheaded by the Ohio Association for Counselors in Private Practice (OACPP).  If you want to get involved and continue the conversation, attend this event 11/21/25 at 12pm!

OCA Link Tree: https://linktr.ee/ohiocounseling

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