A therapist finishes a session at 10:50 and has ten minutes before the next one. In that gap she returns a call from a prospective client who wants to know whether his plan covers therapy. She checks a payer portal for reauthorization, then starts the progress note she will finish at night.
None of that is clinical work, and in many outpatient behavioral health practices nobody else is assigned to do it. The administrative seat that a primary care office would treat as basic infrastructure — someone who owns intake, eligibility, and authorizations — is often missing, shared thinly, or folded into the clinician’s day. The published evidence suggests that gap carries a real cost for clinicians and for the people waiting to see them.
What Surveys Say About the Work Around Care
In 2023 the National Council for Mental Wellbeing commissioned The Harris Poll to survey 750 behavioral health workers. A third said they spend most of their time on administrative tasks, and 68% of those who provide care said that time takes away from time they could spend directly supporting clients. Ninety-three percent said they had experienced burnout, and 62% described it as moderate or severe. Fifty-eight percent of care providers said their waitlist was longer than ever.[1]
The American Psychological Association’s 2024 Practitioner Pulse Survey of 853 licensed psychologists points the same way. More than half (53%) had no openings for new patients. About a third (32%) reported feeling burned out, rising to 51% among psychologists within 10 years of their doctorate.[2]
The same survey shows where administrative friction changes who can get care. One third of psychologists (34%) were not in network with any insurance. The survey asked 374 psychologists who had never taken insurance, or had stopped, to name their top barriers. Sixty-two percent named administrative issues such as pre-authorization requirements, audits, or being unable to resolve problems with an insurer. Fifty-two percent named payment reliability, including payment delays and refund demands.[2]
When the paperwork of insurance has no owner, some clinicians solve it by leaving networks, and insured patients lose options.
Prior Authorization Lands Harder on Behavioral Health
Prior authorization is a good example of work that grows quietly. The 2024 CAQH Index, which tracks administrative transactions across US health care, reports that specialists and behavioral health providers spent more time on prior authorizations than generalists because of the complexity of their services. Providers and staff reported spending an average of 24 minutes per authorization request made by phone, fax, or email, and 16 minutes through a health plan portal.[3]
The American Medical Association’s 2025 prior authorization survey of 1,000 physicians covers all specialties, not behavioral health alone, but its staffing findings are useful. Practices completed an average of 40 prior authorizations per physician each week, and physicians and their staff spent 13 hours a week on them. Forty percent of physicians had staff who work exclusively on prior authorization. Ninety-five percent said the process delays access to care. When asked why they do not appeal adverse decisions, 52% cited insufficient practice staff or time.[4]
In a larger medical group, a dedicated authorization coordinator absorbs those hours. In a small behavioral health practice, the same hours land between sessions.
Why the Seat Stays Unfunded
Burnout in this field is not new. A review of the evidence in Administration and Policy in Mental Health and Mental Health Services Research found that between 21% and 67% of mental health workers across studies may be experiencing high levels of burnout. The authors noted that some workload drivers, such as paperwork requirements tied to Medicaid reimbursement, come from larger systems outside an organization’s immediate control, and that burnout is associated with turnover that disrupts continuity of care.[5]
Practices cannot rewrite payer rules. What they can decide is who absorbs the work those rules create. An administrative role does not bill for sessions, so it is often the first position left open when budgets tighten. The work does not go away. It moves to clinicians, whose hours are the hardest in the building to replace.
Three Staffing Structures That Protect Clinical Time
There is no single right model, but practices that keep administrative work away from clinicians tend to do some version of the following.
- Give the front door one owner. One named person handles new inquiries, collects insurance details, and verifies eligibility and behavioral health benefits before the first appointment. That includes checking whether the plan routes mental health benefits through a separate administrator, whether an authorization is needed for the first visit, and what the plan actually covers. Surprises at the first session are hard on anyone, and harder on someone who has just found the courage to ask for help.
- Run authorizations from a calendar, not from memory. Keep a simple tracker of every active authorization with its approved visit count and end date and start reauthorization requests well before the limit is reached. The administrative owner prepares and submits the request and follows up with the payer. The clinician is asked only for the clinical information the payer requires, ideally in one structured request rather than a series of interruptions.
- Draw a line between clinical documentation and administrative paperwork. Progress notes and treatment plans belong to clinicians. Insurance forms, payer correspondence, scheduling changes, and records requests do not. The administrative seat can be an in-house hire, a role shared across a group of practices, or remote support. Whoever fills it should have access only to the records the job requires, and practices that hold substance use disorder records covered by 42 CFR Part 2 need that person to understand its consent rules before handling any disclosure.[6]
Start With One Week of Honest Numbers
Before changing anything, measure the seat you are already paying for in clinical hours. For one week, ask each clinician to log minutes spent on non-clinical tasks. Count the authorizations that expire in the next 30 days and how many already have a renewal in progress. Count the first appointments where benefits were not verified ahead of time.
Most practices find the answer quickly. The question is not whether someone is doing the administrative work, but whether it is the right person.
Adwait Rajhans is Head of GTM and Revenue Strategy at myMedCrew, the healthcare staffing arm of CrewBloom. myMedCrew places remote administrative and revenue cycle staff with US medical practices, home health agencies, dental groups, and behavioral health organizations. His focus is how provider organizations cover intake, billing, and authorization work without pulling clinicians away from patients. For more information, email [email protected].
References
- National Council for Mental Wellbeing. “New Study: Behavioral Health Workforce Shortage Will Negatively Impact Society” (survey conducted by The Harris Poll, February 2023, 750 behavioral health workers). April 25, 2023. https://www.thenationalcouncil.org/news/help-wanted/
- American Psychological Association. Barriers to Care in a Changing Practice Environment: 2024 Practitioner Pulse Survey. December 2024. https://www.apa.org/pubs/reports/practitioner/2024/practitioner-pulse-2024-full-report.pdf
- CAQH. 2024 CAQH Index Report, Prior Authorization section (2023 data). https://www.caqh.org/hubfs/Index/2024%20Index%20Report/CAQH_IndexReport_2024_FINAL.pdf
- American Medical Association. 2025 AMA Prior Authorization Physician Survey (fielded December 2025, 1,000 practicing physicians). https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
- Morse G, Salyers MP, Rollins AL, Monroe-DeVita M, Pfahler C. “Burnout in Mental Health Services: A Review of the Problem and Its Remediation.” Administration and Policy in Mental Health and Mental Health Services Research. 2012;39(5):341-352. https://pmc.ncbi.nlm.nih.gov/articles/PMC3156844/
- Electronic Code of Federal Regulations. 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records. https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2
