Newsletter 4 | January 22nd, 2026

Today, five of the largest health insurance companies in the U.S. were called in front of Congress. Together, they control about half of the private insurance market.

On paper, the hearings were about “lowering health care costs.”
In real life, they were about the systems that are making it harder for occupational therapists to do their jobs and for patients to get care.

1. Prior Authorization = A Hidden Tax on Therapy

Congress focused heavily on prior authorization.

What that means for OT:

• You spend hours justifying care that is already medically necessary

• Visits get delayed or cut

• Patients fall off your schedule because approvals take too long

• Care plans get watered down to fit what insurance will allow

One of the most important facts from the hearing materials:

Over 80% of prior authorization denials that are appealed get overturned.

Insurance is denying care that should have been approved in the first place. In both meetings today, insurance companies were called out for automatically denying services so that the money can sit in high-yielding interest accounts for 'a little longer'. One official even suggested they were doing this in a hope that the patient and provider would simply 'give up' trying to appeal.

That’s not utilization management. That’s access control.

For OT, that means:

• You’re doing extra work to get patients what they already qualify for

• Patients who can’t wait or can’t fight just lose care

• Clinics eat the cost or stop taking certain plans

2. Administrative Work Is Exploding — Not Patient Care

Congress acknowledged that about one-quarter of all U.S. health care spending is now administrative.

Not treatment.
Not therapy.
Not outcomes.

Paperwork. Billing. Prior auth. Appeals. Credentialing. Utilization management.

For OT, that means:

• More time on the computer

• Less time treating

• Burnout

• Smaller clinics struggling to survive

• Therapists leaving clinical practice

This is why your day feels heavier even if your caseload hasn’t changed.

3. Big Insurance Companies Own More of Healthcare Than You Think

The hearings also focused on vertical integration.

That means:
Insurance companies now also own:

• Physician groups

• Pharmacies

• PBMs (pharmacy benefit managers)

• Specialty clinics

• Data + utilization companies

For OT, that means:
The same company that decides if your OT visit is approved may also own:

• The provider down the street

• The pharmacy

• The care management company

• The data system making the decision

For independent OT clinics, this matters because:

• Big systems get paid differently

• Smaller practices have less leverage

• Market power shifts away from community-based care

• Rehab becomes easier to cut

4. Rising Costs Are Being Used to Justify Cutting Access

Insurers are pointing to rising healthcare costs.

That’s real.

But what OT feels is this:

• Costs go up → insurers tighten rules

• Rules tighten → therapy becomes harder to access

• Clinics close → fewer options for patients

• Remaining clinics get overwhelmed

This is exactly what many practitioners are seeing throughout the United States
Fewer outpatient options.
Longer waits.
Fewer OTs.
More barriers.

What This Means for OT 

This isn’t just “insurance being annoying.”

This is a system that:

• Makes OT harder to deliver

• Makes small clinics harder to run

• Makes vulnerable patients lose access

• Pushes therapists toward burnout or out of practice

• Turns medically necessary care into a negotiation

Why This Hearing Matters to You

These hearings mean that:

• Congress knows prior auth is a problem

• Congress knows admin burden is a problem

• Congress knows consolidation is a problem

But knowing doesn’t equal fixing.

OT voices — especially outpatient, neuro, geriatrics, and community-based care — are rarely centered in these conversations.

That’s why OT stakeholders speaking up matters.

Because when therapy disappears quietly, patients don’t just lose visits.
They lose independence. Safety. Participation. Quality of life.

Action Steps:

Watch the Committee Hearings

• Full Ways and Means Committee Hearing 
• Full Energy and Commerce Committee Hearing 

Complete the OT Report Form (Any Time)

This short feedback form allows all occupational therapy stakeholders — including clinicians, educators, administrators, and students — to submit:

• Concerns

• Barriers

• Highlights or wins

Submissions help document real-world OT experience and support aggregated advocacy efforts.

👉 Submit a report here: https://forms.gle/uQ7jwYTZ2qY3PcAK8

Looking Ahead

These hearings show that the challenges occupational therapists face are no longer invisible. Prior authorization burden, administrative overload, and consolidation are now part of the official Congressional record.

But hearings alone do not change daily practice.

If occupational therapy is not consistently represented in these conversations, decisions will continue to be made about OT — without OT at the table.

In the months ahead, it is critical that OT practitioners, clinic owners, educators, and professional leaders:

• Document access barriers

• Track denials and delays

• Share real-world impact on patients

• Speak collectively about how these policies affect function, safety, and independence

Policy shapes practice.
If we are silent, the system will continue to shape OT without us.

United States Occupational Therapy Clinician Coalition (OTCC)
📧 [email protected]
📱 @USOTCC
🌐 https://www.usotcc.org