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Let's look now at a big change being brought by the health care law. Insurers are now required to cover mental health to the same degree they cover medical needs. Mental health experts say that could dramatically affect the business model for psychologists, psychiatrists and therapists. It'll be a big change for patients, too, and also for a profession that has largely stayed independent from the corporate medical world. Sarah Varney reports.

SARAH VARNEY, BYLINE: In the corporate world of American health care, with its hospital chains and large doctors' groups, therapists are still mostly mom-and-pop shops. Barbara Griswold is a marriage and family therapist in San Jose, California.

BARBARA GRISWOLD: Therapists are like cats. You know, we're just wildly independent little creatures.

VARNEY: Griswold say the inclusion of mental health as an essential insurance benefit under the federal health law and the passage of the Mental Health Parity Act were huge victories for her profession. Insurance companies, for example, must charge the same co-pays and deductibles for mental health as they do for medical conditions. And patients used to paying $150 for a visit will, with some limitations, be covered by their health plan, says Dr. Katherine Nordal of the American Psychological Association.

DR. KATHERINE NORDAL: I do think some people have paid for mental health and behavioral health care out of pocket because they didn't have mental health insurance. I think to the extent that individuals have health insurance, they are going to expect their providers to accept the health insurance.

VARNEY: That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time. Griswold, who wrote a book called "Navigating the Insurance Maze for Therapists," says the transition from the cash-only model can be a little rough.

GRISWOLD: You know, a lot of people come to me, and they're, like, practically falling apart. It's almost like a therapy session with these therapists. Seriously. I had a woman cry on my couch, and she's just, like, I don't know how to do this.

VARNEY: Therapists who already accept insurance take a big pay cut. Fees are about half of what they charge for cash visits. One insurer recently asked Griswold to take up to 30 percent off her already discounted rate for patients covered under the new insurance exchange. She said no, and then wrote about the negotiations in her popular newsletter.

GRISWOLD: Oh, I put out in my newsletter, I said, you know, do you even know what you signing? Here is what you're signing, here. And people wrote back, oh, my God. I had no idea what I was signing. I just signed it.

VARNEY: In many ways, therapists are encountering what medical doctors have complained about for years: the confusing and confounding, some might say hostile insurance bureaucracy that providers must tangle with in order to get paid. Erica Savino Moffatt is a psychiatric nurse practitioner in Boston.

ERICA SAVINO MOFFATT: Just keeping up with all of that, quite frankly, is exhausting. And if you're, you know, Jane Therapist hanging her shingle, you know, in an office down the street from her home, it used to be that the benefit was maybe a better work-life balance, control over your immediate work environment. But a large degree of that is lost in trying to track all of these logistics.

VARNEY: The changes are part of a remaking of a system that has long treated the mind as separate from the body, says Linda Rosenberg of the National Council for Behavioral Health. And consolidation of mental health providers is coming next.

LINDA ROSENBERG: If you look at how many airlines there are today versus 10 years ago, if you look at hardware stores versus Home Depot and Lowe's, it's really a monopoly economy. And I think solo practitioners are now going to be employees of big systems.

VARNEY: It will also give psychologists, psychiatrists and other therapists more bargaining power to set rates, says Dr. Nordal.

NORDAL: For those mental health practitioners who can develop group practices, they can provide the full range of services, from psychotherapy to family therapy to marriage therapy to medication management, they are going to be in a much better position to negotiate not only with commercial carriers, but also with the federal government.

VARNEY: In addition to supersizing mental health practices, Nordal and others say therapists are beginning to play a bigger role at primary care clinics. For instance, Savino Moffatt, a newly minted graduate, chose to work at a large clinic in Boston instead of starting her own practice. She sits alongside internists and pediatricians who previously didn't know where to turn to for help when their patients needed mental health services. Now, the psychiatric nurse practitioner is just down the hall.

MOFFATT: Once you say, hey, I'm here, you know, and I do psychiatry, that they kind of look at you and go, oh, thank goodness. You know, I really need your help. I've got this patient. I just don't know what to do. I'm so worried.

VARNEY: That allows physicians and nurses to better serve their patients, she says, and it also saves the clinic from ordering costly and unnecessary tests. That's especially important to large medical groups like Savino Moffatt's that receive a set amount of money each month to cover all the needs of their patients. Mental health experts say setting up these new business models will take time, that it's a marathon, not a sprint. That's probably the right speed, says Barbara Griswold.

GRISWOLD: I tend to think therapists tend to overreact about change. We're not really good with change, which is funny, because we help people with change.

(LAUGHTER)

VARNEY: For NPR News, I'm Sarah Varney.

(SOUNDBITE OF MUSIC)

INSKEEP: Sarah Varney is a reporter with our partner, Kaiser Health News, which is a nonprofit news service. And, of course, we'll continue to bring you updates as we learn more about the rollout of the Affordable Care Act, also known as Obamacare.

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