Two Tiers Are Coming to Mental Healthcare

Written By Laura Bellows

Mental healthcare in America is splitting in two. You should know what each tier looks like — because soon, you'll be choosing between them.

Tier 1: Quality care, paid out-of-pocket (or via OON benefits).

  • 45–50 minute sessions

  • A therapist who knows your story

  • Real continuity over months and years

  • $150–$300+ per session

Tier 2: High-volume, insurance-covered care.

  • 15–20 minute "therapy" sessions

  • AI chatbots between visits

  • Frequent therapist turnover

  • Measurement-based protocols over relationships

  • Owned by giants like Optum, CVS/Aetna, Cigna

By 2030, analysts expect 60–70% of mental health services to be controlled by these vertically integrated giants. Independent practices — like the one you may already be part of — are becoming the exception, not the rule.

This isn't fear-mongering. It's already underway.

What can you do?

  • Use your out-of-network benefits aggressively

  • Push your employer for better mental health coverage

  • Support independent practices when you can

  • Ask your representatives to enforce mental health parity laws

The therapy relationship you've built has value. It's worth protecting.

Laura Bellows
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