July 2025: The Payor Games You Didn’t Sign Up For

Payor Pressure Points – Parity, Ghost Networks & Other Hidden Hurdles

Jul 09, 2025

July 2025: The Payor Games You Didn’t Sign Up For

Payor Pressure Points – Parity, Ghost Networks & Other Hidden Hurdles

In July’s Masterminds discussion, we took a hard look at the escalating pressure points facing mental health and SUD providers in today’s payor landscape. Erin Burke (CEO, Hansei Solutions) and Christopher A. Parrella, Esq. (Founder, Parrella Health Law), peeled back the curtain on the latest tactics used by insurers to delay payments, bury provider networks, and block access to fair reimbursement.

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✅ Action-Oriented Takeaways

Map the Ghost Network: Call listed providers, confirm operational status, track bed availability, and use that data to compare across payors.
Document, Don’t Delay: Proactively compile evidence of network inadequacies and parity violations before denials start stacking up.
Challenge Ambiguity: Consider whether declaratory actions may help bring clarity to recurring issues like detox level designations.
Use Your Voice: Silence is a tool used by payors—push back early and often. Even if it feels like you’re beating a dead horse.

What We Covered

🕵️ Ghost Networks
A deep dive into payor directories revealed a troubling reality: many listed providers are not actually credentialed, operational, or accessible. A case study out of Tennessee exposed how 14 payors claimed access to 140 beds—but only 10 providers actually offered them. Attendees stressed the need for data-driven audits to expose these inaccuracies and demonstrate true network adequacy.

💰 Payor Playbooks Decoded
From overpayment demands and federal recoupments to slow-walked credentialing and pre-payment reviews, providers shared how these tactics are used to withhold revenue or retroactively claw it back. Misaligned sub-acute detox authorizations and inconsistent ASAM level designations—especially in states like California—were flagged as ongoing hurdles.

📉 Key Updates from Tricare, Anthem, and TriWest
We also examined reimbursement slowdowns and contract challenges tied to several large payors. Delays in rate negotiations and shifting criteria—such as requirements for CARF accreditation—are having a direct impact on cash flow, particularly for detox and residential levels of care.

🔍 Parity Violations
We discussed real-world examples of how to use the Parity Act as more than a compliance requirement—it’s a tool to fight back when behavioral health care is sidelined. Legal strategies like declaratory actions were mentioned as a way to prompt policy clarification and challenge treatment denials.

Final Thoughts

This session wasn’t just about surfacing frustrations—it was about equipping providers with practical tools to push back. Whether you oversee clinical operations, handle billing, or manage compliance, these insights are essential to protecting both revenue and patient access.