Health plans are increasingly steering members with milder mental health concerns toward behavioral health coaches and digital wellness tools instead of licensed therapists. 

Insurers frame these coaching programs as providing faster access to care and “early intervention” for members with mild symptoms. But in practice, the line between “helpful support” and “clinical gatekeeping” may be getting blurry — especially when coaches are operating without the clinical training that therapists bring to the session.  

And it’s easy to see that health plans have a HUGE financial incentive for these coaching programs:  They save money by diverting as many members as possible away from more costly psychotherapy.

A look at one plan: United Healthcare’s coaching programs

United Healthcare (UHC), the world’s largest health plan, has launched and expanded two major coaching programs in the last 3 years:

January 2023 — Adults: UHC launched its Virtual Behavioral Coaching program for adults, offering an eight-week program to members experiencing mild depression, stress, and anxiety. Five million members were offered access to video, phone, or text support from wellness coaches, supervised by licensed mental health professionals. The program promises appointments within 48 hours, secure messaging, and educational resources

2023 — Children and families: UHC later introduced the Child and Family Behavioral Coaching program for children, teens, and caregivers with low-severity issues including anxiety, ADHD, bullying, depression, and sleep difficulties. The program was structured similarly to the adult coaching model but was initially offered only as a benefit that select employers could purchase.

August 2026 — Expansion of the child / family program: UHC expanded the child and family program to more than 13 million members, now at no added employer cost.  

7 reasons we should ALL be concerned

At first glance, the pitch sounds appealing: faster access, lower barriers, and help before problems escalate. But for therapists, the obvious question is not whether support is useful — it is whether a non-clinical coaching program is being asked to do clinical work that a licensed therapist should be doing.

1. Screening tools used as full triage:  The UHC website admits that they rely solely on self-administered screening tools like the PHQ-9 and GAD-7 to triage clients, determining which clients have mild symptoms (who will be referred for coaching) and which have more severe symptoms (who will be referred to a therapist).   But brief rudimentary questionnaires are a far cry from a comprehensive clinical evaluation performed by a trained therapist.  
2. Can coaches assess and treat?  While wellness coaches are certified, they may only have a bachelor’s degree in a health-related field.  They are unlicensed – not even pre-licensed.  Therefore, they are not legally permitted to assess, diagnose or treat mental health conditions – of ANY severity.  Yet this program has coaches assessing and treating clients who have been diagnosed with a wide range of mental disorders, including anxiety and depression, which they do not have the clinical training to treat.   
3. Risk can hide behind ordinary symptoms:  Since a wellness coach is not trained in clinical assessment or risk evaluation, they might miss more subtle yet serious underlying issues.  A coach might see a 13 year-old child presenting with “perfectionism” and roll out their perfectionism module.  In the process, they may miss more serious OCD, eating disorder, self-harm risk, or trauma that a trained therapist might have uncovered during assessment.
4. Cost savings “Band-Aid” or quality care?  While UHC points to reduced therapy usage post-coaching as proof of success, a lower volume of claims after coaching could simply mean members were diverted away from necessary clinical treatment.  The coaching program is only an 8 week program, and coaching sessions are only 30 minutes, so clients get very little direct care.  Redirecting patients into this lower-cost tier may offer only a short-term fix, increasing the likelihood of relapse when deeper issues remain unaddressed. 
5. How much supervision, really?  While UHC states the coaches “work under the oversight of licensed clinicians,” supervision details (such as the frequency and type of meetings and reviews) are not detailed.
6. Don’t clients deserve licensed care regardless of severity?  Clients experiencing mild mental health issues still deserve access to licensed therapists. Plus, if they are funneled into coaching, an escalation in symptoms could force them to be transitioned to an unfamiliar licensed therapist in the middle of a crisis.
7. Wave of the future?  Other health plans are rolling out similar coaching programs to members, sometimes incentivizing members to use coaching before seeking therapy.  That trend should concern clinicians if coaching, AI, and digital solutions become a substitute for therapy. 

The takeaway

While coaching can complement therapy or assist individuals without clinical conditions, those presenting with mental health concerns of any severity require and deserve professional evaluation and treatment.  Unlicensed coaches lack the necessary training to diagnose or gauge risk, meaning they should not act as first-line triage. Clinicians are uniquely equipped to identify when seemingly mild symptoms indicate more serious underlying issues, and to intervene if symptoms escalate.

Health plans should not design programs that require, reward, or quietly nudge members toward wellness coaching instead of therapy when clinical care may be indicated.  Instead of substituting licensed care with unlicensed coaching, insurers should boost reimbursement rates to attract qualified licensed providers with years of training and experience, thereby building larger provider networks and ensuring ALL members have timely access to quality clinical care.