Several Maryland and Washington, D.C.-area behavioral health providers have not received reimbursement from payers like Cigna and CareFirst Blue Cross Blue Shield at all in 2026.
Some small and medium-sized organizations have been forced to make tough decisions as a result. This has ranged from taking out loans to continue operations, conducting staff layoffs and even halting care for patients who are members of these health plans or trying to work with them on alternatives, industry insiders told Behavioral Health Business. Dozens more have come forward acknowledging similar issues with the two payers on social media.
Dr. Ajita Robinson, executive director of Bethesda, Maryland-based Friends in Transition Counseling, said her organization has not received any reimbursement payments from CareFirst, one of the region’s primary insurers, since December 2025. In total, she said her organization is owed more than $400,000 in unpaid claims.
Cigna has since sent a payment of $78 for its part, but Robinson said she is still missing around $126,000 from the payer.
BHB reached out to Cigna for comment on the delayed payments and has yet to receive a response.
Robinson’s practice has 207 employees across seven states. On April 6, it stopped taking clients who have Cigna and CareFirst Blue Cross Blue Shield, she told BHB.
“We cannot continue taking Blue Cross Blue Shield or Cigna while they’re not honoring their contractual obligation,” Robinson said. “We’ve been talking to clients about what it means to use private pay services, because our clients with Blue Cross Blue Shield have to essentially opt out of using their insurance in order to see a clinician in our practice, because technically we are in network despite the fact that they’re currently in breach of contract.”
During this time, Robinson said the company has nearly depleted its savings and that she has even dipped into her personal savings to make payroll for her employees. She herself has not taken pay in four months from her clinical practice because she is trying to avoid conducting layoffs. These are measures she has not had to take in her career in over 14 years, she told BHB.
Dr. Carrie Singer, board member of Orchard Mental Health Group, a Rockville, Maryland-based practice with around 150 providers, told BHB they are experiencing the same situation. Around 70% of Orchard’s patients get their care through CareFirst Blue Cross Blue Shield, and as an organization, they have yet to receive payment from the insurance provider in 2026.
“We’ve been fronting payroll, salary and benefit costs for 150 providers and 50 admin staff now since about mid-December, and that’s made things incredibly difficult,” Singer told BHB. “Operationally, we’ve had to reduce our admin staffing by about 25%, even though we need them more to be leaning in and processing these claims; we can’t afford any unnecessary overhead. We’ve had to reduce some clinicians as well. Unfortunately, we’ve had to roll back some increased benefit offerings we had planned for the year.”
Singer said she is aware that CareFirst switched its claims processing tool and suspects that might be a reason for the delay.
A spokesperson for CareFirst confirmed this to BHB and noted it is working to rectify the delays.
“We’re in the final stages of a planned multi-year move to a new claims and enrollment platform, and we’re making steady progress,” a CareFirst spokesperson said. “The latest stages have caused some processing delays, and we know this has affected our trusted network of providers. We appreciate their patience and partnership, especially the teams handling member claims.”
This is hardly a new issue in the behavioral health sector. Delayed payments do happen and depending on how long the delays persist, they can force operators to make challenging decisions around staffing, layoffs and budgets.
Because in the U.S., 91% of metropolitan areas have at least one payer controlling about 30% of the market, and in some cases, one payer controls half of the market in 48% of metropolitan areas, per the American Medical Association, issues like delayed payments in a certain region can be detrimental for smaller providers.
“Unfortunately, I think a lot of these practices blossomed during COVID, because there was such a patient demand, but now the financial risk of operating a business has just become so challenging,” Singer said regarding smaller providers in markets that are heavily controlled by one or two payers.
Robinson sees it more as an issue with how value-based care arrangements are playing out across the field. She said it limits the amount of care clients receive and there aren’t many checks and balances in place to prevent it. When insurers and large technology-backed platforms own the insurance product and control care delivery to some extent while also owning patient data, she said, this is a recipe for worsened experiences for small and mid-sized provider groups.
“We’re going to continue to see rising premiums with lower access to care, with more poor health outcomes, because that’s what a value-based system does,” Robinson said.
Robinson has reported the latest issue with delayed payments from CareFirst and Cigna to the Maryland Attorney General’s Office and the Office of the Inspector General.
Both Singer and Robinson said that if the payment issues are not rectified soon, they may consider doing what some of their peers in the industry have already done: end the contracts.
To prevent issues with payment delays in the future, ideally there would be “additional oversight,” Robinson explained.
“I think that we need to look at the way that tech companies and insurance companies are controlling the mental health industry, and what that actually means for a patient care and patient advocacy perspective, and what it means from a health indicator and outcome perspective,” Robinson said. “If clinicians, on average, are working two jobs just to sustain a living wage, insurance companies should not be able to report record profits while decreasing coverage for patients and denying rate increases that [could support] livable wages for providers.”
Singer said she knows complaints have also been filed with the Maryland Insurance Administration, but has not heard anything back yet on the progress with that.
In the meantime, without receiving payments, Singer said Orchard Mental Health will be forced to continue downsizing and not accept new intakes for plans that are not paying.
Robinson said she has not had to conduct layoffs yet, but that could be on the horizon if the $400,000 in outstanding claims payments continues to compound.