Michael Desposito

Behavioral health is entering a period of rapid consolidation. If counselors do not organize strategically, we risk marginalization or absorption into larger systems. Hospitals negotiate with infrastructure, data, and capital. Independent counselors — or counselors working within fragmented agencies — often negotiate as individuals. That imbalance affects reimbursement leverage, contract stability, policy influence, and long-term sustainability. At the same time, venture-backed platforms and...

Behavioral health providers, particularly professional counselors, face unique challenges in navigating the insurance landscape. One of the less-discussed but critical barriers is antitrust law. Antitrust laws are federal regulations designed to prevent price-fixing and anti-competitive behavior in the marketplace. In practice, this means independent counselors are legally prohibited from collectively negotiating reimbursement rates with insurance companies. Even discussing specific...

One of the most common questions I hear from counselors is, “Why don’t we just unionize like nurses?” It is a fair question, but the legal and structural realities are very different. Let’s break it down. Most nurses work as employees within hospitals, health systems, schools, or large organizations. Because they are employees, they may have rights under federal labor law, such as the National Labor Relations Act, to organize unions and collectively bargain over wages, working conditions, and...