Episode Summary: Anneliese Hanson, Licensed Clinical Counselor

Podcast: Becker’s Healthcare Podcast
Air Date: September 19, 2025
Host: Scott Becker
Guest: Anneliese Hanson, Licensed Clinical Counselor

Overview

This episode features a conversation with Anneliese Hanson, a licensed clinical counselor and former behavioral health network market manager for Cigna. Anneliese brings her unique insight from both payer and provider perspectives, discussing current trends in mental health insurance, obstacles to mental health coverage, the rise of cash-pay mental health practices, and her advocacy and education work on insurance policies—primarily via TikTok.

Key Discussion Points & Insights

1. Anneliese Hanson’s Background and Bifocal Perspective (00:29–03:11)

• Professional Journey:

  • Licensed in six states; started career in Minnesota/Chicago, later transferred to California.
  • Held various roles at Cigna, including complex case management and network market management for behavioral health across the Western U.S.
  • After the pandemic, transitioned into private practice as a counselor.

• Unique Perspective:

  • Gained comprehensive knowledge from both the insurance payer side (claim contracting, regulatory issues) and the provider side (practical challenges, real-world impacts of regulations).
  • Engages in advocacy and education, focusing on regulatory issues, legal cases, and state-specific mental health laws.
  • Outreach through social media, particularly TikTok as @my_goth_therapist:
    • Content revolves around insurance, regulatory nuances (e.g., ERISA, data privacy laws), and practical advice for therapists—not just mental health tips.

Memorable Quote
“I think one of the most surprising things is how interested people are in insurance and especially how insurance interacts with mental health.”
— Anneliese Hanson, 02:58

2. Current Trends in Mental Health Insurance & Barriers to Coverage (03:11–08:08)

• Coverage Remains Difficult:

  • Mental health providers face “death by a thousand cuts” due to administrative hurdles.
  • Most therapists are solo practitioners (over 72%), making them vulnerable to disruptions.

• Impact of the Change Healthcare Data Outage:

  • Outage led to claim submission halts, practice closures, layoffs, and forced many to exit insurance networks.
  • Many providers opted for cash-pay models to avoid administrative uncertainty—limiting access for patients reliant on insurance.

• Prepayment Reviews (PPRs) as a Barrier:

  • Payers use PPRs—requiring extensive clinical documentation before payment—as a workaround to deny or delay claims.
  • Non-licensed staff can’t outright deny claims, so they stall via technicalities (incorrect format, missing codes) and repeated information requests.

Memorable Quote
“So what they do is instead of denying the [therapy] code… the insurance companies are instituting PPRs which are called prepayment reviews…[they] will say, ‘We need full clinical case notes for all these claims before we pay them’… And so on, and so on, and so on.”
— Anneliese Hanson, 04:43

• Chilling Effect:
  • Persistent PPRs lead many providers to leave insurance, exacerbating access shortages for insured patients.

3. Rise of Cash-Pay Practices & Access Crisis (08:08–08:45)

• Economic Incentives:
  • For small business or solo practitioners, avoiding insurance (and its obstacles) makes sense financially if a cash-pay patient base exists.
  • The trend locks out those unable to afford out-of-pocket mental health care.

Memorable Quote
“If you’re a small business owner, it makes more sense financially if you can run a cash pay practice. I mean, you’d do it, right? 100%.”
— Anneliese Hanson, 08:33

4. Public Interest in Insurance Policy & Grassroots Education (08:55–11:09)

• Growing Consumer Awareness:

  • Ordinary individuals—not just providers—are taking an active interest in how insurance law and company policy impact their care.
  • Viral TikTok videos cover trending issues like Cigna’s proposed “physician downcoding” rule and state-specific mandates.

• Contrast with Providers:

  • Many mental health professionals resist learning about insurance, which Anneliese considers short-sighted.

Memorable Quote
“I’m really excited about how many consumers… have taken an interest in insurance recently… For whatever reason, talking about insurance on TikTok really seems to resonate with people.”
— Anneliese Hanson, 08:56

• Advocacy:
  • Anneliese sees her educational content as a way to empower the public, drawing attention to the direct impacts of insurance policy on real lives.
  • She’s exploring new parity law arguments for increasing reimbursement rates.

5. Where to Follow Anneliese & Resources (11:20–12:45)

• Social Media:
  • TikTok: @my_goth_therapist (most active)
  • Instagram: Same handle (reposts from TikTok)
  • LinkedIn: Limited use
  • Gemini Counseling and Consulting: Offers therapy and insurance consulting for providers, with in-house legal expertise.

“We offer insurance consulting, particularly with behavioral health – how to navigate your plan, how to read your EOB, how to negotiate a claim denial… geared towards providers and practice owners.”
— Anneliese Hanson, 12:17

Notable Quotes & Moments

| Timestamp | Speaker | Quote | |-----------|---------|-------| | 02:58 | B | “I think one of the most surprising things is how interested people are in insurance and especially how insurance interacts with mental health.” | | 04:43 | B | “Instead of denying the [therapy] code… insurance companies are instituting PPRs which are called prepayment reviews…” | | 08:33 | B | “If you’re a small business owner, it makes more sense financially if you can run a cash pay practice. I mean, you’d do it, right? 100%.” | | 08:56 | B | “I’m really excited about how many consumers… have taken an interest in insurance recently…” | | 12:17 | B | “We offer insurance consulting, particularly with behavioral health – how to navigate your plan… how to negotiate a claim denial… geared towards providers…” |

Episode Flow with Timestamps

• 00:00–00:29: Introduction & Anneliese’s White Sox fandom
• 00:29–03:11: Professional background & focus on both sides of the industry
• 03:11–08:08: Difficulties in getting mental health coverage; rise of prepayment reviews
• 08:08–08:45: Economic rationale for cash-pay practices, implications for patient access
• 08:55–11:09: Surge in public interest in insurance policy; TikTok as an educational tool
• 11:09–12:45: Where to follow Anneliese; details on Gemini Counseling and Consulting
• 12:45–12:57: Episode concludes with friendly banter about the Chicago White Sox

Tone and Style

The conversation is candid, slightly irreverent, and advocacy-driven. Anneliese brings a direct, sometimes lightly humorous touch, especially in discussing social media and insurance red tape.

For Further Exploration

• TikTok: @my_goth_therapist
• Website: Gemini Counseling and Consulting (resources for providers, legal consulting)

This episode will be of particular interest to mental health professionals, healthcare policy advocates, and patients or consumers navigating the complexities of insurance for behavioral health. Anneliese’s dual expertise offers rare clarity into both the political and practical landscapes shaping the industry.