Most therapists should apply to three or four payers concurrently: Aetna, Cigna, their state's Blue Cross Blue Shield plan, and UnitedHealthcare/Optum where its panel is open, plus Medicare for LMFTs and MHCs, who have been eligible since 2024. Match the list to the insurance your prospective clients actually carry, not to national market share.
Picking payers is the first real business decision of an insurance-based practice, and it's harder to undo than it looks: once you're contracted, the rate is locked until renewal, and leaving a panel is its own project. The decision runs on data you already have, starting with which cards your consult calls actually mention.
Which panels come first?
The four major commercial networks (Aetna, Cigna, Blue Cross Blue Shield, and UnitedHealthcare/Optum) cover most commercially insured adults, so your shortlist starts there. One naming trap: "the Blue" in your state may not be Anthem. BCBS is a federation of 33 independent licensees, and you credential with the one that holds your state, whatever it's called locally.
Rates differ more than most people expect. Here's what the four majors pay for common therapy CPT codes, from CMS Transparency in Coverage data, with CPT 90837, the 60-minute session most therapists live on, highlighted:
| Session type | Aetna | Anthem BCBS | Cigna | UnitedHealthcare |
|---|---|---|---|---|
| 60-min therapy90837 | $108–$154 | $101–$172 | $68–$151 | $110–$154 |
| 45-min therapy90834 | $74–$105 | $73–$120 | $63–$105 | $75–$105 |
| Initial evaluation90791 | $124–$175 | $117–$189 | $70–$161 | $131–$179 |
| Family therapy90847 | $84–$114 | $83–$124 | $67–$118 | $92–$122 |
| Interactive add-on90785 | $10–$15 | $10–$16 | $3–$13 | $11–$15 |
Ranges are P20–P80 from CMS Transparency in Coverage data. Rates vary by state, locality, and contract negotiation. Look up rates by state, payer, and CPT code
90837 is also the code that draws utilization-review letters at some payers, UHC/Optum most notably. A higher rate can come with more billing friction, so factor that in, not just the dollar figure.
Don't stop at rates, though. A payer that pays $15 more per session but insures nobody in your zip code is worth less than a mid-rate payer covering the school district and hospital system where your clients work. Tally the carriers your last ten consult calls named. That tally beats any market report.
Expect Optum to say no in many metros
Apply to Optum knowing the likely answer in a major metro is a denial citing network capacity. Optum's behavioral panels are closed to new solo providers in many saturated markets, and the denial letter is about their provider count, not your qualifications. Plan your revenue around the other three majors and treat an Optum approval as upside.
The normal arc looks like this: file all four majors in the same week, watch Aetna, Cigna, and your Blue approve over three to five months, and receive Optum's capacity denial within a few weeks. Providers who join the waitlist and keep a call log are routinely credentialed months later, when the panel reopens for their county, without redoing the application. An eight-month wait after a three-week denial is a common version of that arc, not a failed application.
When you get the capacity denial: ask to be added to the panel waitlist in writing, ask provider relations whether any nearby counties or specialty sub-networks have openings (capacity is tracked locally, and the general "closed" status hides pockets), and note the network-adequacy angle: if UHC members in your area genuinely can't find in-network care, payers have an exception process for admitting providers to fix the gap. Timelines here are the payer's to control; see how long credentialing takes for what the waiting actually looks like.
Headway and Alma, or direct credentialing?
Whether you hold the contract at all matters as much as which panels you pick. Headway, Alma, Grow, and Rula panel you under their group contract: live in weeks, billing handled, no CAQH wrangling. The trade is that the contract and the rate are theirs. You can't negotiate it, you can't take it with you, and it can drop without your signature: Optum cut rates paid through platforms in late 2024, and therapists found out by email.
| Factor | Direct credentialing | Headway / Alma |
|---|---|---|
| Time to billing | 3–5 months | 2–6 weeks |
| Who holds the contract | You | The platform |
| Rate | Yours to negotiate at renewal | Set by the platform; can change |
| Billing admin | Yours (or your biller's) | Handled |
| If you leave | Panel status stays with you | Panel status stays with them |
A common pattern is both: join a platform for cash flow now, run direct applications in parallel, and shift caseload to your own contracts as they land. The full comparison is in Headway/Alma vs. getting credentialed yourself.
Don't skip Medicare if you're an LMFT or MHC
Since January 1, 2024, LMFTs and mental health counselors can enroll in Medicare and bill independently, a door that was closed to these licenses for decades. Enrollment runs through PECOS, and Medicare pays MFTs and MHCs at 75 percent of the clinical psychologist fee schedule. The population is enormous and chronically underserved for therapy. If you're eligible, this belongs on your list alongside the commercial payers; the walkthrough is in Medicare enrollment for LMFTs and LMHCs.
Where Medicaid fits
Medicaid pays 30 to 50 percent below commercial rates in most states, and it delivers the steadiest referral demand you'll find. Credentialing runs through each managed care organization (MCO) separately rather than one state application, so a state with four MCOs means four applications. It's the right track when serving lower-income clients is core to your practice, and a poor fit when you're optimizing per-session revenue; the trade-offs are laid out in Medicaid credentialing for therapists.
How to actually decide
Work the framework below with real numbers, then file everything that scores in the same week; your slowest payer sets the calendar either way. Panel acceptance is always the payer's call; what you control is picking payers whose members are actually your clients and filing complete applications concurrently. (Checking which panels are open for your license and state before you apply is part of what paneled.ai does at intake.)
Step 1: Count what you already see. Tally the carrier named in your last 10 consult calls or referral inquiries. Any carrier named 3 or more times goes on the candidate list automatically.
Step 2: Map your local market.
- The three biggest employers near your practice (hospital, university, school district, city government), and which carrier runs their plans (ask a current client, or check the employer's benefits page)
- Which carriers sell individual/marketplace plans in your county
- Your state's Blue licensee (it may not be Anthem)
Step 3: Score each candidate (1 point per box).
- Named by 3+ prospective clients in Step 1
- Covers a major employer or the marketplace in my area
- Panel is open to my license type in my state (call provider relations and ask before applying; 10 minutes saves months)
- 90837 rate at or above my floor of $[AMOUNT]
- Admin burden I can live with (prior auth, utilization review letters)
Score 4–5: apply now. Score 2–3: apply, expect a wait or a waitlist. Score 0–1: skip for now.
Step 4: Add the non-commercial tracks.
- LMFT or MHC: Medicare via PECOS (eligible since 2024)
- Serving lower-income clients: state Medicaid MCOs (one application per MCO; list yours)
Step 5: Platform, direct, or both.
- Need revenue within 6 weeks: join Headway/Alma now and run direct applications in parallel
- Can wait 3–5 months: direct only, so you keep the contract and the rate
Step 6: File everything the same week. Concurrent applications cost nothing extra. The slowest payer sets your timeline; sequential filing multiplies it.
Common questions
- Which insurance panels should therapists join first?
- Start with the payers your prospective clients actually name: for most therapists that's some mix of Aetna, Cigna, your state's Blue Cross Blue Shield licensee, and UnitedHealthcare/Optum. Apply to three or four concurrently, treat Optum as a maybe in metro areas, and add Medicare if you're an LMFT or MHC.
- Is Optum accepting new therapists?
- In many metro areas, no. Optum's behavioral panel is closed to new solo providers, and a denial citing network capacity is the expected outcome, not a reflection on your application. The recourse is the waitlist, a network-adequacy exception if clients can't find in-network care, or reapplying when the panel reopens.
- Can LMFTs and mental health counselors take Medicare?
- Yes. Since January 1, 2024, LMFTs and mental health counselors can enroll in Medicare through PECOS and bill independently. Medicare pays these license types at 75 percent of the clinical psychologist rate, and the population is large and chronically underserved for therapy.
- Should I join Headway or Alma instead of getting credentialed directly?
- Platforms get you billing in weeks instead of months, but they hold the payer contract: you're paneled under their group, at their negotiated rate, and the rate can change under you, as it did when Optum cut platform rates in late 2024. Direct credentialing is slower but the contract and the rate are yours.
- Is Medicaid worth it for therapists?
- Medicaid pays roughly 30 to 50 percent less than commercial insurance in most states, but demand is deep and referrals are steady. Credentialing runs through each managed care organization separately, not one state application, so it's its own track. It makes sense if serving lower-income clients is central to your practice.
The paneled.ai team · Credentialing specialists. We file and track insurance credentialing applications for behavioral health providers every day — these guides come from what we see go wrong (and right) in real applications.