The Chatbot Will See You Now: Big Tech In Therapy (from Organized Money)

Dan: Hey there – 

Health insurance is supposed to cover therapy. It’s been the law for more than a decade.

But try telling that to your insurance company. Finding a therapist who takes your insurance — it’s a huge challenge, and it has not gotten easier. 

Ask any therapist, and they’ll tell you: Insurance companies underpay them, and bury them in paperwork. I’ve heard from therapists who say some insurers even seem to put up roadblocks to going “in-network.” 

So, a bunch of tech companies have jumped into the breach, promising to make things easier. 

Some of them you’ve probably heard of. Others operate behind the scenes.

In both cases it means: big tech is sneaking into your therapist’s office – during your session.  Accessing your most personal discussions without you even knowing. 

So: This week, we’re sharing an episode from our friends Matt Stoller and David Dayen (Day-en) at the podcast Organized Money – it’s a show all about monopolies. 

Because here’s what none of those companies tell you or your therapist:

• One: They’re recording and transcribing your sessions — you know, your most private conversations — for their own use.
• Two: They’re using those transcripts to train AI therapists — that they hope will one day replace human therapists altogether.
• And three: they may hand some of that data over to their corporate partners or investors — which include advertising companies and INSURANCE companies

It is ALL SO CREEPY. Honestly kinda scary and so completely gross. 

I mean, this is a story about a profession full of people who got into it to help others — and about what happens when the business world decides: that desire to help people is a weakness to exploit. 

And:  there’s actionable news in this story. A provider I see actually USES one of these platforms — next time I see them, we are going to talk about what I’ve learned, and what we can maybe do about it.

Especially because:  There’s some good news in this episode too– from my home state of Illinois. 

A new law that may help millions of people get insurance to pay for therapy — WITHOUT creepy tech companies getting in the middle. 

I will be telling everybody I know here about it. 

And you might end up wanting to tell your own state legislators about it. 

I’m telling you: I’m glad we can bring you this story.

By the way: We are doing a lot behind the scenes at An Arm and a Leg right now– taking some time to make some big plans, and some of us may sneak in a vacation. 

So over the next couple of months we’ll be bringing back some of our favorite stories, and maybe one or two from other folks like this one. Stick with us, there’s good stuff coming. 

And take care of yourself. 

Now, here’s Organized Money.

David Dayen:  So if you’re a podcast listener, you probably know a company called Better Help. You maybe not, don’t know anything about the company, but you know that it disrupts your podcast. 

Ad: Hey guys, I wanna take a quick break to thank another sponsor of today’s episode. Better Help. What are your self-care non-negotiables?

Maybe you never skip leg day or a therapy day when 

David: you’re scheduling a shocking amount of money has been spent, uh, to, uh, find you the podcast listener and tell you to sign up for this thing called Better Help. Matt, what is better help? 

Matt Stoller: So it is a, a, a matching service for, uh, therapy. So what happened is there was this huge boom in demand for therapy, uh, starting during the pandemic period, and a bunch of we’re gonna, this episode is about the business of therapy, the.

And, um, it’s a story about ai, it’s a story about corporatization. It’s also a story about independent business and public utility regulation. And better help is, is important because it represents the kind of attempt to corporatize this, uh, industry. So they’re a matching engine between patients and therapists.

They spent, uh, a hundred million dollars on podcasts. I mean, it was, they bankrolled the industry. Our producer just just told us he, he’s produced a lot of podcasts. He said they bankrolled the industry, which is kind of true until the, until gambling. Right gambling picked up the slack and now you got, you got both sides, right?

You got give you a gambling problem and then give you help, uh, for your gambling problem. Uh, but we’re gonna learn about some of the scandals and problems with better help, but also more broadly, what is going on with the therapy profession at this moment of ai. It is really interesting. There are a lot of echoes.

Uh, and parallels with some of the things we see across the economy. There’s some very creepy stuff in here as well, like AI training on  therapy sessions and like all the dystopian things that you’re gonna be totally shocked by, but also you will completely expect because of course they’re happening 

David: and, and, uh, our guest.

Is named Linda Michaels. She is a psychologist. She’s in private practice in Chicago, and she’s the co-founder of the Psychotherapy Action Network, which is trying to get the word out about these uh, issues in therapy. She’s a consulting editor of Psychoanalytic Inquiry Clinical Associate Faculty at the Chicago Center for Psychoanalysis and eighth.

Fellow at the Lauder Institute, global MBA program, which means she knows what  she’s talking about. And she has studied this business, uh, and has been, you know, on the front lines as a, as a therapist in private practice. And so she’s gonna tell us about what, what’s happening in the industry and what’s happening with these new technological shortcuts really, or innovations, uh,  as well as a kind of, um, way that.

Uh, these people who are, are helping or, or who, who want to go into a profession to help people, uh, are turned into business people and then are sold a product that could be their salvation, uh, which ends up being very, very  harmful. 

Matt: Well, and also just there’s some good news too. There, there’s, there’s also political push that is partly successful to get access to more therapy for more people.

So it’s a really interesting story. Um, anyway, organize money. Let’s get to it.

David: I’m David Day. I run the American Prospect Magazine. 

Matt: And I’m Matt Stoller. I write about monopolies in a newsletter called Big. And I’m the research director for a think tank called the American Economic Liberties Project, 

David: UN Organized Money. We’re gonna go beyond supply and demand curves and OES to visionary entrepreneurs and tell you  how the business world really works.

Matt: We’ll talk to business leaders, journalists, policy makers, people on the front lines who are dealing with monopoly power, competing with it, winning, losing, but ultimately fighting back. It’s a podcast about all the money and power. In the world, 

Theme: and  we know now that government, by organized money is just as dangerous as government by organized mob, mob, mob. 

Matt: Welcome to the show. 

Linda: Thanks so much. Great to be here. 

Matt: You know, this is a show we, we talk about social problems, but we’re also, we’re a show about business. So tell us about the basics of the business side of therapy. Like how does a therapist make money? Who pays them? How many therapists are in America?

Like is it mostly independent practices? Is it, who do they work for? Like, give us a snapshot of the industry. 

Linda: Yeah. Um, a lot of therapists are, I don’t know exactly how many there are in the states. I should know this. Um, but a lot are mom and pop shops. Um, you know, one person.  Local businesses, people who get into therapy, the therapy profession want to help people and that’s their main goal and interest in, in what they do.

And then when they get into the profession, they realize, oh wow, I’m a small business owner. Whoa. There’s a lot of stuff I, I didn’t really learn about at, at any point, and now I’m responsible for this aspect of my practice and, um, to get started, a lot of therapists do tend to participate in network with insurance companies, and so they will accept whatever the reimbursement rate is that the  insurance company.

Uh, dictates that often is much, much lower than what the going rate market rate is for therapy. 

Matt: So, so there’s, so they’re basically, they’re small businesses and they get paid by either the patient or by an insurance company of the patient who reimburses, who, who gives them a reimbursement. 

Linda: Yeah. And  then the therapist has to decide, you know, is this worth it for me to continue?

To get reimbursed and network by the insurance company on their terms. Um, and it’s not just financial terms, but it’s also the administrative requirements that the insurance companies, um, create. Uh, you have to comply with  all of that. And you’re also at the mercy of the insurance company, um, deciding what is, quote medically necessary care.

Now that sounds like an important term and like something, you know, people might learn about in med school. But actually it’s, it’s not at all that it’s a, it’s an  insurance industry term, medical necessity. It’s an insurance industry term that the insurance industry came up with, um, that they can use to justify not paying for care when they don’t.

Think it’s warranted. Even though of course they’ve never met your patient, they’ve never evaluated your patient. They may not even be a psychotherapist. Um, but they can say, well, we’ve decided we don’t think this care is medically necessary. So because of the low, the combination of low reimbursement rates and high admin burden.

Many therapists, particularly as they gain experience over time, decide, you know what, I, I just don’t wanna work this way.  It’s, it’s not, uh, allowing me to provide the quality, ethical level of care that, um, I want to provide for my patients. And so they stop participating with insurance and become what we call a self pay private pay.

Outside of the insurance system where Matt, as you said, the  patient just directly pays the therapist. Yeah. Um, and then the patient might go back to their own insurance company after the fact to get reimbursed themselves. 

David: I mean, that’s certainly what I’m familiar with in the therapy I’ve had in my life.

I just wrote a check, uh, every week or however many times I saw the therapist.  Um, and, uh. I never actually made an attempt to, to, uh, try to get it reimbursed with insurance after the fact, although maybe I could have. But, uh, I think there’s a lot of, there’s a, a, a, not a, a terribly. Robust amount of  understanding of the sort of payment structures behind this, that the, the, what insurance would cover, what insurance wouldn’t cover.

Uh, people think it’s, oh, I’m, I’m going to, I mean, they, it’s weirdly disassociated from the health profession, like I think in the minds of a lot of people is does that make sense?  Like 

Linda: Oh, absolutely. And, and actually the original reason for that is that. Decades ago, 60 seventies when health insurance plans started to be offered by employers, uh, the original health insurance plans did not cover mental health at all.

David: Right. 

Linda: It was only for medical surgical, um, and so there was no coverage, so just there have to have been a lot of legislative pushes along the way to even get insurance companies to cover psychotherapy. 

David: Right. And there was a policy, right? There was a mental health parody  act that was passed, uh, as part, I think, of the Affordable Care Act that that was supposed to provide for much, uh, a much greater mental health, uh, coverage option.

But I, I don’t know that that’s filtered down to the population. 

Linda: Yeah, I think, you know, the population is confused. Like does, we actually have done several large market research studies with the US public and, um, big samples, over 3000 individuals surveyed. And um, you know, most people don’t even know if the health insurance plan they currently have.

It covers mental healthcare or not. Um, it’s really confusing and also therapists are confused about it. But actually the original parody act, um, to get coverage for mental healthcare on an equal basis was passed in 2008. Then strengthen later by the a CA. 

Matt: If I don’t get therapy, can I be reimbursed for my incredibly violent temper and alcoholism?

Did my insurance company help me with that? Is that, or is that, that’s like old school treatment, is that what you call it? Like, okay. Yeah, 

Linda: yeah. 

David: I mean, it’s a joke, but, but the point is that 

Matt: it’s a joke, but I am an alcoholic with a violent temper. Like, 

David: no. Well, maybe you’re, but the, the point  is that 

Matt: no 

David: judgment, 

Matt: wait, 

David: no shame.

The point of the point of having a mental health. Kind of safety net is, is so that, uh, we don’t resort to, to these things that are disruptive and costly to society, right? I mean, that’s the whole point of why you wanna cover mental health. Uh, mental health to begin with.

Matt: I want to establish the boundaries of the, of the situation.

We’ve talked a little bit about how, how insurance companies don’t really cover enough. Mm-hmm. And, uh, but Illinois, I know, I understand that Illinois just passed a law that would address this problem, and it’s really interesting, and we have a rule on this show because we talk about monopolies, that everything has to be like really a bummer, except one thing on the show can be good news.

Um, and then we promise everything else will make you sad. Okay? But this is the one thing that is good. So tell us about this law and what it, uh, what it’s for, what it does, and if it’s had any impacts. 

Linda: Yeah, so the  law is in Illinois. It’s a state law. It’s House Bill 10 85, and it was passed last year in 2025.

And what it does, it was, you know, took massive effort, coordination for many advocacy groups, et cetera. Um, and what it does is. It tries to correct a  lot of the wrongs, um, that the insurance companies and their policies have instituted and, um, on, on, on the field. So, for example, it, you know, as things stand now, most insurance plans pay therapists about 20% less than the Medicare rate,  whereas most insurance plans pay medical doctors or surgeons 20 to 30% more than the medical rate.

Um, so that is, is addressed in this law. The, the percentage of based on the Medicare rate is bumped up for therapists to be more in line with, um, with medical surgical. So that’s good. That doesn’t take effect until 2027. So to your ques, you know, it’s a little early to see any changes or results from this, but, um, what it also does.

Is it improves, it, it tries to take on the admin burden that we were talking about. The,  um, you know, to get a therapist, if I really wanna participate and be in network with an insurance company, um, it’s a pain in the ass. Can I say that on the show? Um, of 

Matt: course. 

Linda: Okay. It’s re it’s really hard. I mean, we have a mental health access.

Tell us about 

Matt: how you feel. Yeah. Yeah. 

Linda: We have a mental health access crisis in this country and it’s really hard for a therapist to sign up with an insurance company to participate in their network. You got a bunch of paperwork, it can take months. I mean, this is crazy, right? Um, if I can also use that word as a therapist.

David: So, so, so it seems, and so 

Matt: well that one, that one’s on you. Okay. 

David: That one’s worse. 

Matt: So this bill. Uh, will actually affect how like two and a half million people in Illinois who have insurance is that. 

Linda: Yeah, like basically the projections are because it will, you know, end up paying therapists at a, a fair, a, a more, uh, a fair reimbursement rate.

And because it will make it less burdensome for therapists to do the admin stuff and again, even sign up with the insurance company in the first place. You know, I just wanna mention like. It took me about six months to get, uh, signed up as a Blue Cross therapist, and if I were a medical doctor, that would’ve been about two weeks.

I, I, I mean, we’re talking about massive disparities between the psychotherapy and the medical side. So, um, it’s not just like, I don’t like to do paperwork. I mean, the disparities are real and they’re massive, but all of these changes that are, are addressed, um, in this law in Illinois will equate, you know, it will incent more therapists to participate with insurance.

As opposed to being operating outside as a private pay only practice. More therapists will say, Hey, this is a good deal. I can work with this. I would be happy to do this. Um, I’ll  participate with insurance there. And then that will increase, you know, many op more options that will make many more options available for therapy.

For individuals, they can use their insurance plans to pay for therapy. They’re already buying their insurance plans. They should be able to use it and that now, hopefully they will. And all told this is projected to increase access for individuals in Illinois to the tune of 2.5 million people. 2.5 million more people will be able to access a forward pay for fine psychotherapy in Illinois.

David: We’ve seen AI disrupt industries, you know, throughout the economy, but it seems like it’s disrupting, uh, uh, therapy in the. Most dangerous and worst way. So, uh, uh, how are people using AI for mental health? Yeah. Uh, uh, talk about that and talk about maybe there are benefits you think, or, or, and, and talk about maybe some of the challenges.

Linda: Yeah, for sure. And actually before AI entered the scene, because of all these different dynamics we’ve been talking about, there were a lot of apps launched by tech firms and venture capital. But yes, now it’s, it’s not only apps, but it’s, it’s AI tools and just also general, you know, um, chatbots not even mental health specific.

Chat bots, although there are some of those as well. Um, so yeah, you know, uh, I mean we do, as I said, we do have a serious access crisis in this country. More people need help and care than are receiving it, than can afford it. And so I am all for using technology and tools wisely and, um, you know, with, with care to help people who, who need help.

So, AI tools, you know. They’re immediate, they’re on your phone. You pick up your phone, you can start talking. It’s right there. So there is that immediacy. It can be at a much lower cost, sometimes even free, which is, which is cool. Um, it can be used, I think, well in ways like as an support in between psychotherapy sessions with a trained, licensed professional clinician.

So, of course these tools are not clinicians. They haven’t gone to grad school. They don’t have a license. They don’t abide by  code of ethics. They are a product developed and sold by a technology firm. Um, you know, many of them. BA based on selling advertising. So that is a radically different proposition than a clinician who has gone to graduate school and has learned about psychological and  emotional problems in human development and how best to, to help people with complex problems of life.

Matt: It always strikes me as kind of odd when I read. A story. Occasionally it’ll come across the, the transo, but like, oh, a chat bot told someone to kill themselves. Right. Like it’s like a common thing. 

News: Yeah. 

Matt: And  that strikes me as not necessarily like a grad school problem. That’s just like a, not a, a, I mean, I don’t know.

I guess there 

David: are you saying that chat bot who told the kid to kill himself didn’t have the right credentials? 

Matt: That’s, that’s exactly right. 

David: To do that. 

Matt: But the point is, is they’re not, they’re. Therapists, and they can be really dangerous too. Right? It’s not about, it’s, I’m not, it’s not just that they don’t have the credentials.

They will, they do bad things or they can 

Linda: Totally, and, and also, you know, why do they, I mean, a couple things. Why do they, why do they do bad things like that? Because, um, you know, they are a large language model. They’re just predicting the next word in the sentence. They are focused on  maximizing engagement, keeping you.

Uh, using the product. Um, and so they will say and do anything or, you know, to, to, that’s their main goal. That is not the main goal of therapy. Um, the main goal of therapy is to help people with the problems that they  come in with, the ways they wanna change their lives. Um, the main, uh, my goal as a therapist, I wanna see people graduate.

I wanna see people get better. 

Matt: I, I do remember my therapist told me I was wrong sometimes, which, which, uh, I think is not, and, and was not like flattering me  and was also challenging me to do things I didn’t like. 

Linda: Right. 

Matt: Let me, I just wanna read you a quote. Okay. So this is a quote from Mark Zuckerberg 

Linda: Uhhuh, 

Matt: where he says, I personally have the belief that everyone should probably have a therapist.

It’s like someone they can just talk to throughout the day, or not necessarily throughout the day, but about whatever issues they’re worried about. And for people who don’t have a person who’s a therapist, I think  everyone will have an ai. 

Linda: Well, that’s not what therapy is. Um, you know, I don’t think everyone needs a therapist.

Um, I, I, that sounds like, you know, everyone needs a journal or a diary or a place to like record their thoughts. Okay, fine. Um, but that’s not what therapy is. Um, you know. Therapy is for people who have problems, serious complex problems, multiple problems, problems that maybe go back generations in their families that they cannot unwind or understand or change by themselves.

This is not about, oh yeah, I’m going throughout my day and I, I just wanna record a few voice memos and, you know. See what ha, see what chat. GPT thinks about that. I mean, this, he talks about it so casually. Um, I think it, you know, it, it really sounds to me like he has no idea what actual psychotherapy is for and why people might need it.

Um, and. You know, the, just  going back again as well, I know we were joking about, you know, chat GBT not having gone to grad school. Um, but you know, the, I think the big point here is that these companies are pushing these products used in ways like Zuckerberg is talking about, like, Hey, everyone should use it, they should use it all day long, but these  companies are not being held accountable for the results of that.

David: You referred to this, the fact that it’s more than just ai, that there is now sort of a business model for certain apps that do this kind of, uh, you know, virtual therapy or whatever you want to call it. Could you  talk about some of these, these business models for therapy, these app-based therapy, uh, you know, uh, assistance and things like that.

What are the companies. 

Linda: Yeah, there are several different kinds. I mean, one, one set of companies is, um, you know, centered on trying to teach people skills.  So it’s kind of like a self-help book, but in a, in the form of an app. So they might teach you how to do like deep breathing or meditation or, you know, some, some things like that.

Some educational self-help type. Skills. Great. Okay, fine. That can be useful.  That can, um, I incorporate some of that as a therapist. Um, is that psychotherapy? No, that’s self-help. You know, guided self-help. Um, but there are apps like that. Then there are other apps that match therapists and patients, you know, you can type in as an individual.

Hey, I’m looking in the zip code. I.  I’m self diagnosing myself and I have anxiety and um, you know, I wanna be matched with a therapist and they’ll do a matching. Um, and then they kind of, um, say they get out of the way, but they still operate the platform. You know, they collect your money,  um, and they provide the technology.

Through which you communicate with the therapist. And so they’re still heavily involved that platform and that’s a different kind of app. And some of those companies better help in Talkspace. Um, you know, and I’ve, uh, written a lot about the fact that, um, you know, when a. My organization, psychotherapy Action.

Now were questioned, um, you know, the, some of the ways in which Talkspace was constructing its app and some of the terms and conditions that really conflicted with the, the core nuts and bolts of what makes therapy. Therapy. I mean, they had, uh, business  managers reading. Text transcripts. I mean, imagine you go to a therapy session and then you have some after the fact, some business managers reading everything that you talked about with your therapist.

I mean, it’s such a violation, and all of that wasn’t really clear to the client. And so,  uh, we wrote a couple of letters to the American Psychological Association and, um, in response, Talkspace actually, uh, we got a couple cease and desist letters from them. And then a few short weeks later, Talkspace sued us.

Um, my organization and the three co-founders as  individuals sued us for defamation and libel and $40 million in damages and. Being sued for $40 million as an individual was massively overwhelming and terrifying. Um, and the very next week, of course, our lawyers resigned and said, this is way over our heads.

Good luck to you.  Uh, we finally found pro bono representation through Arnold and Porter in New York, which was amazing. But they said clearly, you know, you have the right to raise these concerns. This is a free speech issue, first Amendment, and, uh, the, the judge. You know, dismiss the case. So, uh, that was a huge relief.

But this is how  these companies operate. Um, if you try to challenge them and they have deep pockets and expensive lawyers to do their tasks, 

Matt: let’s get you into trouble then. Um, and more trouble. Uh, 

liz: more trouble. 

Matt: Yeah. So, so better, better help. And Talkspace are, are brands, you hear them sometimes on podcasts.

What are some of thelegal trouble they’ve gotten into? FTC or or whatever else. 

Linda: Yeah. Yeah. And we were, my organization and others as well, you know, really, uh, pushed the FTC we wrote to them and, uh, you know, really encouraged them to look into better help. And the FTC did actually sanction better help 

News: the online counseling service better Help is giving back nearly $8 million to customers for sharing sensitive health information They promise.

To keep private. 

Linda: The main thing that, uh, that sanctioned better health for was, um, for sharing, sharing confidential private data, mental health data. What could be more private than that for sharing that data from better health customers with social media companies, so that. They could track and target advertise to you when you were on other social media sites,  and this is after Better help in all of their advertisements.

And in 2023, better Help was the top advertiser on podcasts. They spent a hundred million dollars advertising on podcasts. Wow. Yeah. And um, literally all over the place. And, um, they would advertise  like, Hey, you sign up with us as a customer, as a client. Better help. We keep your information safe. And they did not.

Matt: One of the things we haven’t brought up is the importance in therapy of trust. Right. So, so it’s not one of the dynamics here with these, with, with AI or with any of these other, um, tools, is that you’re not actually  building a relationship with another person. How foundational is trust to therapy?

Linda: Without it, uh, therapy doesn’t work. And, and you know, it’s, it’s without, without that, you can’t build a relationship with your therapist. You can’t open up and really talk about and explore what you need to talk about. People go to therapy. Um. With their most vulnerable, perhaps embarrassing and shameful problems and parts of themselves.

And if you are not, you know, if you’re not sure that that information and your most private thoughts, worries, feelings, fears. Behaviors are gonna be kept private. Uh, you’re, it’s, you’re not gonna get help. So trust is paramount. And the very, you know, these, uh, companies, I mean, they are on, you know, they’re walking a very different path.

They wanna make money, they wanna sell advertisements, they want to, um, you know. Garner as much information as they can and monetize your private data. And so they’re, you know, they, they have a totally different game that they’re playing. 

Matt: Let’s talk about therapists themselves and how AI is impacting the profession. And it’s not really ai. I mean, call it ai, but that’s really a, a a a veil through which to disguise other changes  that are happening. So therapists have been signing up for something called practice management companies.

News: Mm-hmm. 

Matt: So there’s, this is, they have names like, um, spring Health, all about rule Headspace growth therapy. Can you briefly like tell us about what practice management companies are? 

Linda: Yeah. Yeah. Practice management companies are a middleman  that sit in between 

Matt: love middlemen, love them. 

Linda: Yeah. Yeah. They’re so good.

I know, I know. They’re the best. Um, they do all good. Uh, they sit in between the insurance company and the therapist. And, uh, they kind of quote unquote, solve a lot of the  problems that we were talking about early on. They take care of all the admin stuff, the billing, signing therapists up with insurance companies in the first place.

You know, all of that admin hassle that we were talking about early on, that is the Bain of existence for most therapists. They do all of that. They also say, we’ll do marketing for you. Um, like, and give you a profile on Psychology Today, for example. Um, they also say, um, we will ensure that if the insurance company comes back and after the fact and says, you know what, we’re actually not gonna pay for those therapy sessions you did.

Six months  ago, nine months ago, two years ago, uh, the, it’s called clawing back money. The insurance companies do clawbacks. 

Matt: They do it to pharmacists too. It’s a, yeah, it’s a thing. Um, yeah, it’s, it’s a clawbacks are not unusual for middlemen, 

Linda: but yeah. So they’ll do the admin, they’ll do marketing, and they also promise to pay therapists, um, more.

Per session of therapy. Then the, they say the therapist could otherwise get on their own from the insurance company because they say, you know, we represent. Tens of thousands of therapists who have joined us, and that gives us negotiating power with the insurance company so we can negotiate a better rate for  you than you could get on your own individual therapist.

So we’ll do all your admin, we’ll pay you more, and we won’t charge you a penny. Most of these are free. There are some that are a monthly subscription fee, but the majority of these practice management companies are totally free to the therapists. It sounds like Golden. Um, it. It sounds too good to be true.

Uh, and that means it is.

David: Hey, it’s Dave. Look, we love making organized money. It’s the best part of our week, and the support that we get from you. It just means everything. We  know you care about this stuff because you’re listening to a show about how money and power actually work. So you’re already in deep here with us. And yeah, we’ve had some pretty incredible guests.

Lena Kahn, Cory Dro, and a certain senator who apparently does laundry with us. Senator Warren, thank you so much for being on Organized Money. 

liz: Oh, thanks for having me. Big fan. 

David: That’s what I heard, that, that you actually listened to this show. 

liz: I do. Uh, you have done laundry with me. Uh, you’ve taken the dog out with me.

Uh, there’s a lot of stuff we’ve been doing together for the last many, many  months. 

David: So here’s the thing, if you want to go deeper with the show, head to. Organize money fm. Sign up, you’ll get transcripts, videos of every episode. Also emails every time a new episode drops. So all the good stuff and if you can swing it, we’d love if you could chip in a donation, literally any amount. 

Helps us keep this going. So go to organize money fm, sign up, maybe kick in a few bucks. We so much appreciate you listening. Let’s keep doing this together.

Matt: So now it, the, the, the PCs, they, they take their money from. The, the revenue that’s supposed to go to the therapist, they presumably they take some of that, do they, do they, do they disclose to the therapist how much they take? 

Linda: No, no. There’s no transparency around that. For the most part. It’s very confusing.

We’ve done a research study on this last year, um, and with  nearly 700 therapists, and it was very confusing. Most of the therapists who are using https://www.psian.org/cs, uh, don’t know. How much the PMC gets paid. They don’t know what cut the PMC takes. They don’t. I, it, there’s no transparency around that. And if, you know, you were to join a  traditional group practice, um.

You would know, the group would say, look, we’re doing a 50 50 split, a 70 30 split. You know, it, it wouldn’t be a secret. You would know. Um, and, uh, you would then be able to calculate how much the practice is doing for you, how much they’re taking, and whether you think that’s a fair deal or not. So 

Matt: who owns these, these pmcs.

Linda: Well, who owns these? Pmcs is also, um, usually quite a mystery. We found that in our research, most of the therapists, the 85%, um, don’t know who owns these  companies at all, um, but who, who actually owns them is, is very interesting. It’s a mix of venture capital. Companies, private equity investors, big tech, Google, Google Ventures for example, and Amazon.

Um, own these companies and also all the big major insurance companies. Blue Cross, Cigna, ever North United, Optum. So these are the owners and therapists do not really understand that. You know, the other thing I should mention is that when they join A PMC, they become a 10 99 contractor to that, to the PMC 

Matt: and the rec, the, the customer records and, and information is owned by.

The PMC or the therapist in that relationship, 

Linda: the PMC, 

Matt: so effectively they start, they just become, uh, not an employee ’cause they’re a contractor, but they just be, they just start working for the PMC. Is that, that’s effectively what’s going on. 

Linda: Yeah, they becau it’s the Uber model. Um, and the PMC is is the Uber, the platform and they get all of the data, they do all the billing, they manage all the money.

They even directly communicate with clients without even telling therapists that they’re doing that. Um, which seems like.  You know, a violation in, in many ways. And, you know, the value proposition I think sounds really different if it were explained. Like for example, um, if, if the PMC value prop was explained in something like, you know, you’re gonna become, it’s an Uber model, it.

You know, we won’t charge you a penny. We will do all this admin stuff. There’s a 50 50 chance that, that you’ll get paid more. We can’t, that’s the best we could say. That’s what our research showed. 50 50. Um, chance that you would actually earn more money going through them. Um, and you know, you’re gonna give up all.

Ownership to of your patient data. So if you ever leave the PMC, you lose all of your patient records. All of that data stays with the platform. Um, and by the way, we know the biggest, the bane of your existence as a therapist are the insurance companies and their policies, but you’re gonna become a 10 99 contractor to a company that is  owned, or, um, major strategic investors are those very insurance companies.

How’s that sound to you? 

David: I’m, I’m imagining that’s not the sale, that’s not the sales. That 

Matt: doesn’t sound You sound, you’re a terrible salesperson. I just say 

David: pc. So you’re never gonna get a job at A PMC. 

Matt: Yeah. Yeah. So, um, what, okay, so, so these pmcs, I mean, I got, you know, I read your report on it, which is, which I thought was really interesting, and one of the things that it suggested is that there are these AI related therapy tools.

That, um, that are, that, you know, pmcs encourage or I don’t know even know if they require, but they, they encourage their therapist to  use. 

Linda: Yep. 

Matt: Um, can you tell us about some of them and what, what do they do? 

Linda: Yeah. Yeah. They 

Matt: actually, because this is, this is where we’re getting to the creepy stuff. 

Linda: Yeah.

Super creepy. I mean, and they really, the, the way they, you know, Matt, as you said, quote, encourage therapists to use these tools is they say, um, you know, if you,  if you, if you use our AI tools, which I’ll explain what they’re in a second, then that’s how you know you’ll get that protection against clawback.

So it’s a pretty strong, so it’s arm twisting, it 

David: forced, they’re forcing you to use it. Yeah. Forced vendor. 

Linda: Yeah. Yeah, yeah, yeah. Um, so  basically the AI tools are, you know, when you go to therapy, when, or you’re. They have a therapy session. If the therapist is going to be billing insurance for that, uh, there needs to be some documentation that the session happened.

You know, so you have to have some basic information. It was on this date, started at this time. You know, this is the diagnosis and this is what we worked on in this session. You have to have some proof that you actually did. A therapy session so that if the insurance company ever says like, where’s the proof that you actually met with this person on this day, you have a document, a note saying that you did the work  and that the treatment was necessary and all that stuff.

And, um, and so, um, a lot of times also insurance companies will want to see a treatment plan. What’s the big picture plan for this person? What’s their progress looking like, et cetera? So there is a  certain amount of documentation that a therapist has to do when the insurance companies are involved. And so with the pmcs, what their documentations using ai, um, do is they say, Hey, let us record the entire therapy session.

We’ll, you know. Most of these, many of these sessions might be having, you might have a Zoom therapy session online. Let us record the entire thing and, um, you know, then we’ll create a transcript of that. And then from there, we’ll. We’ll write the, uh, documentation that needs to be written. 

David: So it’s, so it’s sold as kind of a, a paperwork, uh, improvement.

That We’ll, we’ll, we’ll do the work for you that you need to do. This is all around, I imagine this is all targeted around. Uh, you don’t have to be a small businessman anymore. We’ll, we’ll do that work for you. Mm-hmm. You get to focus on your job and use our clever tools and, uh, you,  you won’t ever have to worry about any friction between you and an insurance company or anything like that.

We take the burden off you. I mean, is that that kind of what the sales pitch is? You’re 

Linda: a better, yeah. You’re a better sales pitch. I’m better than you at it. Yeah. You know, this is all built. On transcripts and recordings of what  people, patients should believe are, should be a private conversation between them and their therapist.

Matt: You know, it just reminds me of, of, we had an episode where on, uh, on gambling apps and one of the things they do is they advertise to, um, to gamblers who are trying to quit. And it just kind  of seems like this would be a like really. Yeah, I mean, you, you’re against it ’cause you’re into privacy, but I’m thinking that it’s gonna be very profitable to know what someone is ashamed of or addicted to for advertising purposes.

And I just would ask you totally to think more positively about the opportunities. 

David: Think about the the, uh, the, um, yeah, the. The 

Linda: possibilities, the advertising potential. Yeah. There’s not only the advertising potential, which is the math. This is an excellent point you raised. Yeah. But there is also, I mean, how did Chad GPT, you know, it was trained on all of the data on the internet, right?

So amassing huge amounts of  data. They ultimately, I think, want all of this data, all of these therapy sessions to train. Their own proprietary LLMs to create. Therapy chatbots that will ultimately be a replacement of a human and much cheaper. 

David: So that’s your view? Yeah. Like do you, yeah. Is is there evidence that these sessions have been used to train AI yet?

Linda: That’s what Talkspace, I mean, Talkspace has talked about that directly in their investor reports. Big time. 

David: Okay. So, oh yeah. So other, other than them bragging about it. 

Matt: I guess the other thing that, I mean, I just kind of jumped to this where I’m like, all right, if I’m. Say a foreign adversary, right? Or even not a foreign adversary.

I would love to get my hands on a database of all the therapy sessions in the co in, in America. Like that seems like a, like a really, uh, I don’t know. Didn’t Nixon like go after, um, what’s his face’s like? He broke into his, like, therapist, psychiatrist, or Daniel. Yeah. I just feels like that’s  crazy to be like, yeah, we’re, let’s do a centralized database of all the therapy sessions.

Uh, I don’t know. I mean, it’s just, maybe we just automate blackmail. I just, it feels like there’s so many really. Like opportunities for new businesses here is kind of my point. 

Linda: Yeah. And you know, how is all of this explained to the  therapist, right? Who uses the PMC? How is all of this explained to the patient?

Right. I mean, headway, which is one of the, the largest PMC says, you know what therapist, you can use our AI documentation tools, and you don’t even have to tell your patient, because actually our, the way our AI tool works is you type in a summary. We don’t  record the whole thing, the whole session. So you don’t even have to tell your patients that you’re using AI in any way, shape, or form.

Mm. You know? I mean it’s like crazy. Um, and headway, I should mention is currently being sued for in a class action for allegedly sharing patient data with Google. And  is Google one of the owners of Headway? It sure is. And so isn’t that convenient? I mean, it’s very scary. Yes. Your private data is being used to, for advertising.

Your private data is being used to help them build. LLM, you know, chatbots that will ultimately be a different product that is not a psychotherapist, but, uh, yeah. You know, and it’s not transparent to anybody who consented to that. 

Matt: I just, I guess I want to, I think this has been really interesting and I, I kind of wanna close it out on a.

Optimistic note, even though we’ve already done that. Let’s go for it. We already did one. Do it again. We didn’t wanna do it again, but I’ll do the same optimistic note, which is when I started studying this space, and you’ve helped me educate me on this, which I really appreciate, but it occurred to me that what we’re really looking at is two paths.

One path is what we saw with Illinois. Where we actually, the, the, we actually used politics to provide care to more people. It’s not like any of the AI chat bots and stuff have gone away. It’s just that now there’s also,  there’s therapy that’s available to people. The the other path is to not give people therapy and ultimately to destroy this profession and this technique of healing people.

Um, and, and instead substitute this technology, which may or may not have beneficial, um, implications, but it really is. It isn’t actually like,  oh, AI chatbots are coming in and doing like healthcare thing. It’s actually like a political choice. Are we gonna use resources to get people care or are we going to, um.

Uh, to actually move more resources to effectively, like Wall Street, Silicon Valley types. 

Linda: Mm-hmm. 

Matt: Um, 

Linda: absolutely. So 

David: move fast and break  people, I think is uh, that’s right. The way to think about it. 

Linda: Yeah. 

Matt: Um, alright, well listen, thank you so much for joining us. I’ve, I’ve really enjoyed, was 

Linda: that the high note?

I’m sorry. 

Matt: Well, no, I mean, the, the, well, the No look, I mean, two and a half million people in Illinois now have access to mental. To, to, to mental healthcare. Like that’s a big deal. I, it shows 

David: there’s a, I could, it’s a choice, right? I mean, people, uh, politicians policy has the ability to say, actually no, you can’t just manipulate this industry to your own devices.

So yeah, I do think that’s a 

Matt: huge, I think it’s, I think it’s huge. I think 

Linda: it’s 

Matt: a huge deal. Think 

Linda: it’s, it’s fantastic. Yeah, I totally agree. 

Matt: And we have this, we have a narrative problem where when something good happens through politics is just kind of discounted. Something good happened in politics.

Where we come together as a society and make a choice. We made that choice in Illinois and yeah, if it happened in Illinois, it can happen elsewhere. So I look at this and I’m thinking, this is actually like, if it’s a choice, we can make the choice. If it’s not a choice, if it’s inevitable, then right there is no, there’s nothing you can do.

So I do feel like this is this, there is something really important there. 

Linda: Absolutely. 

David: How are you using, you know, your psychotherapy action network and, and these things to get the word out about exactly what’s happening in the industry? 

Linda: Yeah, I mean, you know, trying to have conversations just like this one.

And you guys have been amazing and, and your interest in this and you know, one of the projects that we’re working on in our policy committee is to write a model bill based on the Illinois. Legislation mm-hmm. That other states can use and pick up. And, um, so, you know, we’re trying to push the ball forward for sure.

And educate the  public, educate clinicians as well, you know, to what is really going on. All these, uh. These levers and, uh, companies and corporate models and how everything really works so people can make more informed choices. 

David: Great.  Uh, Linda Michaels, uh, psychologist and also co-founder of the Psychotherapy Action Network.

Thank you for being on Organized Money. 

Linda: Thanks so much.

Matt: So I’ll just tell you, when I was, I guess in my early twenties, the reason I went to therapy is because I had this coworker who was just like a total asshole who, you know, I would be on the, I would be on a sales call. I would try to sell someone, somebody, and he would be criticizing me. While I was on the call about what I was saying, like he was just such an asshole.

He kept, I kept out. 

David: He’s our guest next week. He’s our guest. I  forgot to tell you. 

Matt: He’s a, he’s, uh, he runs the world now. Um, actually, it’s true. He’s in private equity. I, I’m not, 

David: it’s rah Emanuel and he’ll be on next week. 

Matt: Yeah. Anyway, I, at a certain point I kinda like lost it and I had a cup of lukewarm coffee, which I knew was lukewarm and I just, he kept bugging me as I was on the phone and I just threw it at him.

And he got like stoked with, withcoffee. And I had two bosses. It was a super well run company, right? So like, um, and one of the bosses came to me and was like, Matt, that is totally unacceptable. And I was, I was very sheepish. And he’s like, you have to get therapy. This is unacceptable. And the other boss had me walk around, he tucked me outside and he walked me around the block and  we were just like, silent.

And then we, um, and he knew what this guy was doing and he, like, we got back to the, the, the front of the office and he said, just don’t make a habit of it. But that’s what I went, there are 

David: two ways to judge, uh, to, to, 

Matt: so I went to therapy and it was, it was a really good experience. It helped me, you know, all the cliches, get in touch with your feelings and,  and, and understand yourself a little bit better, and all of those things.

Like, it really does. It can, I mean, it can be in this incredibly powerful thing. Deal with depression and all, you know, all the, all the things. It can do that and does do that for a lot of people. So this is, uh, an art and a craft that we have, and I just think it’s important to  preserve it. To expand it.

And, and that that’s actually what’s happened in, right. I mean, I 

David: think the real takeaway from this episode is that to the extent that it’s an art and, and a practice, uh, that requires a certain amount of skill and talent. It’s maybe a law start or, or an art that we are on the precipice of losing because of this  sort of, these technological forces and also these sort of corporate forces that are pushing into the industry.

Matt: Right. They’re not technological forces. Exactly. They’re corporate forces. Right. What’s happening is the same sort of, of vertically integrated like monopolization that we see everywhere from cattle ranching to. Hollywood, whatever, um, big  tech is, is happening here because there’s, people looked at this industry and said, what’s a fragmented industry that helps people that we can destroy?

Ah, I have an MBA, let me get found 

David: it. 

Matt: Yeah. Um, and, and I think that that is, um. That that’s, we have to understand there’s a hundred thousand people in America who do this for a living. They just take nice things and smash them. And at the same time we also see this populous pushback. So a public utility law, which is, and they are like they, I said that there’s two paths, but I think it’s, it’s.

Hard. What? What? It’s hard to convey that. Basically the problem is insurance companies don’t wanna pay for mental, mental health care. ’cause they wanna keep the money. And you can either force them to pay for that care because you’re already paying them, or you can have them not pay for that care and use a bunch of technological gobbledygook.

To, to pretend that they’re offering you something. And that’s really what this is all about to me. 

David: Yeah, I mean, this has been a fight that has gone through decades, uh, to get mental health coverage to be established as sort of, uh, a right and to be established as healthcare. This goes back to Paul Wellstone.

This was one of his signature, uh, uh, policy ideas. Uh, Al Franken picked it up, that’s why it was in the Affordable Care Act and. You know, it’s the kind of thing where policy thought they solved  the problem, uh, because, oh no, we did a mental health parody bill, and so it’s all over, uh, every, but, but nobody really knows that you can actually get therapy and get it covered.

And Wall Street or, or corporate forces are, are exploiting that lack of understanding about the nature of, of  this, this product, uh, to, you know, as I said, you know, just. Disrupt the industry. 

Matt: Yeah. Well, um. I, I enjoyed this one. And I also think it’s always cool when you discover a new industry full of small business people, uh, who are doing their thing and they, they get, they kind of get turned on to realizing that what they’re doing is very political.

David: That’s, that’s what’s interesting. I mean, you know, when I was listening to her say, you know, so many therapists got into the industry. Uh, you know, for, for various reasons and then realized that they were small business people. That reminded me of when we talked to Benjamin Jolly  Pharmacies about, uh, pharmacies.

It reminded me of when we talked to farmers about farming. Uh, uh, you know, the way in which, uh, the, the modern economy works, it atomizes everybody and, uh, puts them up against these larger. Economic forces in a way that, uh, can be radicalizing. I mean, uh, I’ve, I’ve seen it with industry after industry. It was a great discussion.

We got another one coming up next week and come on back to organize Money. Organized Money is a production of Rock Creek Sound Executive producers Ellen Weiss and Ari Saperstein. Our senior producer is Benjamin Frisch, who also does our sound design. All the mixing and our artwork. Todd Mensch does our video.

If you love this topic as much as we 

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David: I’m David. 

Matt: I’m Matt Stoller. See you next week.